Şahin Mehmet, Özdemir Merve Şam, Can Osman, Keskin Emin Taha, Özdemir Harun, Şimşek Abdülmuttalip
Department of Urology, Başaksehir Çam and Sakura City Hospital, Basaksehir Olympic Boulevard Road, Istanbul, Turkey.
Department of Radiology, Başaksehir Çam and Sakura City Hospital, Basaksehir Olympic Boulevard Road, Istanbul, Turkey.
Surg Oncol. 2024 Dec;57:102148. doi: 10.1016/j.suronc.2024.102148. Epub 2024 Sep 27.
While radical prostatectomy stands out as one of the most effective curative treatments for prostate cancer, it does come with annoying side effects, such as urinary incontinence (UI). We aimed to investigate the predictability of UI using MRI measurements, along with clinical and disease-related variables.
We included 191 patients who underwent robot-assisted laparoscopic radical prostatectomy between July 2020 and October 2022 in the study. Preoperative MRIs of the patients are re-evaluated by an experienced uroradiologist, and membranous urethral length (MUL), urethra wall thickness, levator ani thickness, outer levator distance, Lee's apex shape, intravesical prostate protrusion length, prostate apex depth, and pubic height measurements were made. Additionally, retrospective data on patients' age, BMI, PSA, PSA density, prostate volume, IPSS, clinical stage, and nerve-sparing status were collected. Patients were categorized into two groups based on continence status in the third postoperative month: continent or incontinent. The definition of UI was accepted as the use of one or more pads per day.
UI was observed in 38.21 % of the patients in the postoperative third month. Among MRI measurements, only MUL showed a significant relationship with UI (p < 0.001). IPSS (p = 0.004) and Clinical Stage (p < 0.001) were also significantly associated with continence status. Logistic regression analysis identified BMI (p = 0.023; CI 0.73-0.97), IPSS (p = 0.002; CI 1.03-1.17), MUL (p = 0.001; CI 0.66-0.90), and Clinical Stage (p < 0.001; CI 1.53-2.71) as significant predictors. In Multivariable Regression analysis, Clinical Stage emerged as the most powerful predictor of UI (p < 0.001).
Except for MUL, MRI measurements may not predict postoperative UI. A combination of IPSS, clinical stage, and MUL effectively informs patients about postoperative outcomes. These findings contribute to enhancing preoperative counseling for patients undergoing radical prostatectomy.
虽然根治性前列腺切除术是前列腺癌最有效的治愈性治疗方法之一，但它确实会带来令人烦恼的副作用，如尿失禁（UI）。我们旨在研究使用MRI测量以及临床和疾病相关变量来预测尿失禁的可能性。
我们纳入了2020年7月至2022年10月期间接受机器人辅助腹腔镜根治性前列腺切除术的191例患者。由经验丰富的泌尿放射科医生对患者的术前MRI进行重新评估，并测量膜性尿道长度（MUL）、尿道壁厚度、肛提肌厚度、肛提肌外侧距离、李氏尖部形状、膀胱内前列腺突出长度、前列腺尖部深度和耻骨高度。此外，收集患者年龄、BMI、PSA、PSA密度、前列腺体积、IPSS、临床分期和神经保留状态的回顾性数据。根据术后第三个月的控尿状态将患者分为两组：控尿或尿失禁。尿失禁的定义为每天使用一个或多个尿垫。
术后第三个月，38.21%的患者出现尿失禁。在MRI测量中，只有MUL与尿失禁有显著关系（p<0.001）。IPSS（p=0.004）和临床分期（p<0.001）也与控尿状态显著相关。逻辑回归分析确定BMI（p=0.023；CI 0.73-0.97）、IPSS（p=0.002；CI 1.03-1.17）、MUL（p=0.001；CI 0.66-0.90）和临床分期（p<0.001；CI 1.53-2.71）为显著预测因素。在多变量回归分析中，临床分期成为尿失禁最有力的预测因素（p<0.001）。
除MUL外，MRI测量可能无法预测术后尿失禁。IPSS、临床分期和MUL的组合可有效告知患者术后结果。这些发现有助于加强对接受根治性前列腺切除术患者的术前咨询。
