Nolsøe Alexander B, Løgager Vibeke, Boesen Lars, Østergren Peter Busch, Jakobsen Henrik, Jensen Christian Fuglesang S, Bruun Niels Henrik, Sønksen Jens, Fode Mikkel
Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.
Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
BJU Int. 2025 Apr;135(4):603-610. doi: 10.1111/bju.16594. Epub 2024 Nov 29.
To investigate the association between pre- and postoperative magnetic resonance imaging (MRI) measurements of the membranous urethra and the prostate volume and continence following robot-assisted radical prostatectomy (RARP).
From December 2018 to June 2022, 100 continent patients undergoing unilateral nerve-sparing or non-nerve-sparing RARP were included in this cohort study. Bi-parametric MRI scans were performed before and 12 months after RARP and measurements included the membranous urethral length (MUL) measured in cm (mMUL) and in the number of image slices (sMUL; 3 mm/slice), the membranous urethral diameter (MUD), and the prostate volume. Urinary function was evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and continence, defined as the use of zero pads and the answer 'never' to the ICIQ-UI SF question regarding incontinence frequency or <8 g urine-loss per 24 h. Regression with robust variance estimates was used to analyse the association between measurements and outcomes.
At 12 months, continence and MRI data were available for 82 patients. The continence rate was 63% and the median (interquartile range) ICIQ-UI SF score was 4 (0-9). Both preoperative MUL measurements were associated with continence at 12 months. Every extra 5 mm of MUL increased the likelihood of being continent by 13 percentage points (P = 0.03) and every additional slice of sMUL increased it by 6 percentage points (P = 0.05). Both postoperative MUL measurements were associated with better continence and lower ICIQ-UI SF scores (P < 0.01). A larger prostate volume was associated with urinary incontinence at 12 months, with a small effect size. The MUD was not associated with continence.
Preoperative mMUL and sMUL are associated with continence at 12 months after RARP. The sMUL may be a useful measurement when only the axial plane is available, and the slice gap is known. Postoperative MUL measurements are strongly associated with continence, while MUD and prostate volume hold minimal prognostic value.
探讨机器人辅助根治性前列腺切除术（RARP）前后膜性尿道的磁共振成像（MRI）测量值与前列腺体积及控尿情况之间的关联。
2018年12月至2022年6月，100例接受单侧神经保留或非神经保留RARP的控尿患者纳入本队列研究。在RARP术前及术后12个月进行双参数MRI扫描，测量指标包括以厘米为单位测量的膜性尿道长度（MUL，记为mMUL）以及以图像层数计的膜性尿道长度（sMUL；层厚3mm）、膜性尿道直径（MUD）和前列腺体积。通过国际尿失禁咨询委员会尿失禁简表（ICIQ-UI SF）评估排尿功能，控尿定义为使用尿垫数为零且对ICIQ-UI SF问卷中关于尿失禁频率或每24小时尿失禁量<8g的问题回答为“从不”。采用稳健方差估计的回归分析测量值与结局之间的关联。
12个月时，82例患者有控尿及MRI数据。控尿率为63%，ICIQ-UI SF评分中位数（四分位间距）为4（0-9）。术前两种MUL测量值均与12个月时的控尿情况相关。MUL每增加5mm，控尿可能性增加13个百分点（P=0.03），sMUL每增加一层，控尿可能性增加6个百分点（P=0.05）。术后两种MUL测量值均与更好的控尿及更低的ICIQ-UI SF评分相关（P<0.01）。前列腺体积较大与12个月时的尿失禁相关，效应量较小。MUD与控尿无关。
术前mMUL和sMUL与RARP术后12个月的控尿情况相关。当仅可获得轴位平面且已知层间距时，sMUL可能是一种有用的测量指标。术后MUL测量值与控尿密切相关，而MUD和前列腺体积的预后价值极小。
