Department of Urology, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119, 08035, Barcelona, Spain; Universitat Autònoma de Barcelona, UAB, Campus de la UAB, Plaça Cívica, 08193, Bellaterra, Barcelona, Spain.
Department of Radiology, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119, 08035, Barcelona, Spain.
Eur J Radiol. 2021 Apr;137:109589. doi: 10.1016/j.ejrad.2021.109589. Epub 2021 Feb 12.
Functional and anatomical changes associated with prostate removal coincide with alterations in pelvic structures. Posterior rhabdosphincter reconstruction was designed to improve urinary continence after radical prostatectomy. The aim of this study was to determine magnetic resonance anatomic predictors of urinary recovery after radical prostatectomy, and to assess their relation to the type of reconstruction.
Forty patients were randomly selected from a trial (NCT03302169). Two independent radiologists determined the situation of the anastomosis in the pelvis according to MRI performed a month after the radical prostatectomy: vertical situation assessed as the distance to the line coccyx-inferior pubic margin (ACPv) and anteroposterior situation as the distance from the pubis (Distance A), and from the coccyx (Distance B).
The Pearson correlation of ACPv, Distance A, and B between readers were 0.975, 0.940, and 0.711, p < 0.001. Patients with the reconstruction presented more cephalic situation of the anastomosis (higher ACPv) than patients with standard reconstruction technique. A multivariate analysis was performed including age, BMI, prostate volume, PRRS, and the MRI parameters. ACPv and Distance B were the only two independent predictors of no need for any urinary protection at 6 months after the surgery.
This is the first study that suggests positional differences according to the type of reconstruction after radical prostatectomy related to early urinary recovery. Magnetic resonance measurements to determine anastomosis positioning are reliable and have a strong correlation between readers. Anatomic MRI features are independent predictors of urinary recovery after robotic radical prostatectomy.
与前列腺切除相关的功能和解剖变化与骨盆结构的改变一致。后阴部横纹肌重建旨在改善根治性前列腺切除术后的尿控。本研究旨在确定根治性前列腺切除术后恢复尿控的磁共振解剖学预测因素，并评估其与重建类型的关系。
从一项试验（NCT03302169）中随机选择 40 名患者。两名独立的放射科医生根据根治性前列腺切除术后一个月的 MRI 确定骨盆中吻合的情况：垂直位置评估为距离尾骨-耻骨下边缘线（ACPv）的距离和前后位置为耻骨（距离 A）和尾骨（距离 B）的距离。
读者之间的 ACPv、距离 A 和 B 的 Pearson 相关性分别为 0.975、0.940 和 0.711，p<0.001。接受重建的患者吻合口的头侧位置（ACPv 更高）高于接受标准重建技术的患者。进行了包括年龄、BMI、前列腺体积、PRRS 和 MRI 参数在内的多变量分析。ACPv 和距离 B 是术后 6 个月无需任何尿保护的唯一两个独立预测因素。
这是第一项表明根治性前列腺切除术后根据重建类型存在位置差异与早期尿恢复相关的研究。用于确定吻合定位的磁共振测量是可靠的，并且读者之间具有很强的相关性。解剖学 MRI 特征是机器人根治性前列腺切除术术后尿恢复的独立预测因素。
