Li Youjian, Li Weijian, Lu Wenfeng, Chen Mengxia, Gao Jie, Yang Yang, Zhuang Junlong, Li Xiaogong, Guo Hongqian, Qiu Xuefeng
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
Institute of Urology, Nanjing University, Nanjing 210008, China.
Transl Androl Urol. 2020 Apr;9(2):501-509. doi: 10.21037/tau.2019.12.17.
Studies regarding predictive factors of urinary continence following Retzius-sparing radical prostatectomy (RP) is limited. This study was designed to evaluate association of urethral parameters on preoperative magnetic resonance imaging (MRI) and immediate recovery of urinary continence following Retzius-sparing robot assisted radical prostatectomy (RS-RARP).
This retrospective cohort study enrolled 156 patients with clinically localized prostate cancer who underwent MRI before RS-RARP. We measured the following structures on preoperative MRI: minimal residual membranous urethral length (mRUL), peri-urethral sphincter complex (PSC) thickness, urethral wall thickness (UWT), the thicknesses of the levator ani muscle (LAM) and obturator internus muscle (OIM). Immediate urinary continence was defined as patients reported freedom from using safety pad within 7 days after removal of urinary catheter. Patients were divided into two groups according the median of each parameter on MRI. We retrospectively analyzed the patients in term of preoperative clinical factors and postoperative urinary continence.
A total of 100 patients (64.1%) reported immediate urinary continence after RS-RARP. Immediate urinary continence was significantly more in patients with longer mRUL (≥8.70 mm) than in patients with shorter mRUL (<8.70 mm; P=0.000). On multivariable analysis, longer mRUL was significantly related to immediate urinary continence after RS-RAPA (odds ratio 8.265; P=0.000). PSC, UWT, LAM and OIM were not associated with immediate urinary continence.
Our results firstly demonstrated that preoperative mRUL measured on MRI was an independent predictor of immediate urinary continence following RS-RARP. Therefore, preservation of membranous urethra is still the anatomical basis of better urinary outcome after RS-RARP.
关于保留Retzius间隙的根治性前列腺切除术（RP）后尿失禁预测因素的研究有限。本研究旨在评估术前磁共振成像（MRI）上尿道参数与保留Retzius间隙的机器人辅助根治性前列腺切除术（RS-RARP）后尿失禁即刻恢复之间的关联。
这项回顾性队列研究纳入了156例临床局限性前列腺癌患者，这些患者在接受RS-RARP之前接受了MRI检查。我们在术前MRI上测量了以下结构：最小残余膜性尿道长度（mRUL）、尿道周围括约肌复合体（PSC）厚度、尿道壁厚度（UWT）、肛提肌（LAM）和闭孔内肌（OIM）厚度。即刻尿失禁定义为患者在拔除导尿管后7天内报告无需使用安全垫。根据MRI上每个参数的中位数将患者分为两组。我们根据术前临床因素和术后尿失禁情况对患者进行回顾性分析。
共有100例患者（64.1%）在RS-RARP后报告即刻尿失禁。mRUL较长（≥8.70 mm）的患者即刻尿失禁的比例明显高于mRUL较短（<8.70 mm）的患者（P=0.000）。多变量分析显示，较长的mRUL与RS-RAPA后即刻尿失禁显著相关（优势比8.265；P=0.000）。PSC、UWT、LAM和OIM与即刻尿失禁无关。
我们的结果首次表明，MRI测量的术前mRUL是RS-RARP后即刻尿失禁的独立预测因素。因此，保留膜性尿道仍然是RS-RARP后获得更好排尿结果的解剖学基础。
