Urology Department, Hospital Universitario Virgen del Rocío, Seville, Spain.
Radiology Department, Hospital Universitario Virgen del Rocío, Seville, Spain.
World J Urol. 2023 Apr;41(4):1147-1155. doi: 10.1007/s00345-023-04320-3. Epub 2023 Feb 16.
Current studies are focusing on the relationship between anatomical variables in preoperative prostate MRI and the development of post-prostatectomy incontinence (PPI). Nevertheless, there is little evidence regarding the reliability of these measurements. The objective of this study was to analyze the concordance between urologists and radiologists for anatomical measurements that might be PPI predictors.
Pelvic floor measurements with 3T-MRI were performed by two radiologists and two urologists independently and blindly. Interobserver agreement was determined using the intraclass correlation coefficient (ICC) and the Bland-Altman plot.
The concordance was good-acceptable for most measurements, except for the levator ani and puborectalis muscle thickness (some ICC values < 0.20/p value > 0.05). The anatomical parameters with the highest degree of agreement were intravesical prostatic protrusion (IPP) and prostate volume (most of the ICC values > 0.60). The membranous urethral length (MUL) and the angle of the membranous urethra-prostate axis (aLUMP) presented ICC > 0.40. The obturator internus muscle thickness (OIT), urethral width and intraprostatic urethral length presented a fair-moderate degree of agreement (ICC > 0.20). Regarding the agreement between different specialists, the highest degree was obtained for the two radiologists and for urologist 1-radiologist 2 (moderate median agreement), while urologist 2 with each of the radiologists had a regular median agreement.
MUL, IPP, prostate volume, aLUMP, OIT, urethral width and prostatic length show acceptable inter-observer concordance and they would be reliable as possible predictors of PPI. Levator ani and puborectalis muscle thickness show bad agreement. Interobserver agreement might not be greatly influenced by previous professional experience.
目前的研究集中在术前前列腺 MRI 的解剖变量与前列腺切除术后尿失禁（PPI）的发展之间的关系。然而，这些测量的可靠性证据很少。本研究的目的是分析泌尿科医生和放射科医生对可能预测 PPI 的解剖测量的一致性。
使用 3T-MRI 对两位放射科医生和两位泌尿科医生进行盆腔底部测量，他们独立且盲目地进行。使用组内相关系数（ICC）和 Bland-Altman 图确定观察者间的一致性。
大多数测量的一致性良好-可接受，除了肛提肌和耻骨直肠肌厚度（一些 ICC 值<0.20/ p 值>0.05）。具有最高一致性的解剖参数是膀胱内前列腺突出（IPP）和前列腺体积（大多数 ICC 值>0.60）。膜部尿道长度（MUL）和膜部尿道-前列腺轴角度（aLUMP）呈现 ICC>0.40。闭孔内肌厚度（OIT）、尿道宽度和前列腺内尿道长度具有适度-中度一致性（ICC>0.20）。关于不同专家之间的一致性，两位放射科医生和泌尿科医生 1-放射科医生 2 之间的一致性最高（中度中位数一致），而泌尿科医生 2 与每位放射科医生之间的一致性为常规中位数一致。
MUL、IPP、前列腺体积、aLUMP、OIT、尿道宽度和前列腺长度显示出可接受的观察者间一致性，并且可能作为 PPI 的可靠预测指标。肛提肌和耻骨直肠肌厚度显示出较差的一致性。观察者间的一致性可能不会受到先前专业经验的很大影响。
