Department of Urology, Pennsylvania State University, Hershey Medical center, Hershey, Pennsylvania, USA.
Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA.
J Endourol. 2022 Jul;36(7):927-933. doi: 10.1089/end.2021.0599.
The aim of this study was to assess the value of the pelvic cavity index (PCI), as an objective pelvimetry feature, to predict operative time, margin status, and early urine continence after extraperitoneal single-port robotic radical prostatectomy (RP). We sought to define an optimal cutoff point for PCI in predicting postoperative outcomes. A total of 94 patients who underwent extraperitoneal single-port robotic RP and preoperative cross-sectional imaging were enrolled. PCI was calculated as follows: . The predictive value of PCI for operative time, surgical margin status, and 3-month urinary continence recovery was assessed using regression models. To report the optimum cutoff value, on receiver operating characteristic (ROC) analysis, we calculated the performance of PCI cutoff points ranging from 5.56 to 10.80 cm by every 0.01 increment. No significant associations were noted between clinical characteristics (including PCI) and operative time. Similarly, other than pathological stage, no clinical variables (including PCI) were predictive of the positive surgical margin. However, a higher PCI was associated with a significantly higher rate of continence 3 months after surgery [odds ratio 2.44 (1.75-5.33); = 0.01]. On ROC analysis, a PCI cutoff value = 8.21 cm yielded the best accuracy (area under the curve = 0.733, 95% confidence interval 0.615-0.851; = 0.001). No association was noted between variables and 6-month continence rates. With a single-port robotic system, the operative time, positive surgical margin rate, and long-term continence after prostatectomy would be independent of the bony pelvic cavity. However, a higher PCI is associated with a higher rate of early continence after surgery. PCI at a cutoff of 8.21 cm has the optimum performance to predict postoperative urine continence recovery. If validated, this information may be helpful regarding patient counseling before single-port robotic RP.
本研究旨在评估骨盆腔指数（PCI）作为一种客观的骨盆测量特征，预测经腹膜外单端口机器人根治性前列腺切除术（RP）的手术时间、切缘状态和术后早期尿控情况。我们旨在确定 PCI 预测术后结果的最佳截断点。
共纳入 94 例接受经腹膜外单端口机器人 RP 术和术前横断面成像的患者。PCI 计算如下：。使用回归模型评估 PCI 对手术时间、手术切缘状态和 3 个月尿控恢复的预测价值。为了报告最佳截断值，我们在接收者操作特征（ROC）分析中，通过计算每 0.01 个增量从 5.56 到 10.80 cm 的 PCI 截断点的性能。
临床特征（包括 PCI）与手术时间之间无显著相关性。同样，除了病理分期外，没有临床变量（包括 PCI）可预测阳性手术切缘。然而，较高的 PCI 与术后 3 个月的控尿率显著相关[优势比 2.44（1.75-5.33）；=0.01]。在 ROC 分析中，PCI 截断值=8.21 cm 时具有最佳的准确性（曲线下面积=0.733，95%置信区间 0.615-0.851；=0.001）。变量与 6 个月控尿率之间无相关性。
使用单端口机器人系统，前列腺切除术后的手术时间、阳性手术切缘率和长期控尿将与骨盆骨腔无关。然而，较高的 PCI 与术后早期控尿率较高相关。在 8.21 cm 的截断值处，PCI 具有最佳的预测术后尿控恢复性能。如果得到验证，这一信息可能有助于单端口机器人 RP 术前患者咨询。
