Ruan Z-T, Li X-D, Lin X-D, Ye X-J, Chen J-Y, Chen Y-H, Zheng Q-S, Xue X-Y, Wei Y, Xu N
Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China; Department of Urology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
Department of Ultrasonography, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Clin Radiol. 2025 Mar;82:106790. doi: 10.1016/j.crad.2024.106790. Epub 2024 Dec 27.
We aimed to evaluate whether preoperative bladder neck thickness (BNT) measured by magnetic resonance imaging (MRI) can guide surgical decisions in benign prostatic hyperplasia (BPH) and primary bladder neck obstruction (PBNO) patients with a small volume (≤30 mL).
The clinical data of 403 patients were retrospectively collected. The Kappa consistency test was used to compare subjective (IPSS-voiding) and objective (Qmax) postoperative outcomes. Multivariable logistic regression identified predictors of the consistency between postoperative objective and subjective evaluations. The receiver operating characteristic (ROC) curve was utilised to identify the optimal preoperative BNT (preop-BNT) cut-off value for predicting residual obstruction.
The Kappa consistency test revealed a significant difference between IPSS-voiding and Qmax improvements (P < 0.001). Multivariable logistic regression identified intravesical prostatic protrusion (IPP), prostate urethral angle (PUA), and preop-BNT as independent factors influencing postoperative outcome consistency. Among 51 PBNO patients confirmed by prostate MRI and urodynamic examination to have residual postoperative obstruction, multivariable logistic regression analysis showed that preop-BNT was an independent risk factor and PUA was an independent protective factor. ROC analysis determined the optimal preop-BNT cut-off value to be 7.50 mm for predicting residual obstruction.
PBNO results in a significant difference between postoperative objective evaluation and subjective evaluation improvement in many of these BPH patients with small-volume prostate. Preop-BNT is a valuable indicator for guiding surgical decisions in these patients. Measuring BNT can help determine whether to preserve or incise the bladder neck during anatomic enucleation of the prostate (AEEP), leading to better postoperative outcomes.
我们旨在评估通过磁共振成像（MRI）测量的术前膀胱颈厚度（BNT）是否能够指导良性前列腺增生（BPH）和原发性膀胱颈梗阻（PBNO）且前列腺体积较小（≤30 mL）患者的手术决策。
回顾性收集403例患者的临床资料。采用Kappa一致性检验比较术后主观（IPSS排尿症状评分）和客观（最大尿流率Qmax）结果。多变量逻辑回归分析确定术后客观和主观评估一致性的预测因素。利用受试者工作特征（ROC）曲线确定预测残余梗阻的最佳术前BNT（preop-BNT）临界值。
Kappa一致性检验显示IPSS排尿症状评分改善与Qmax改善之间存在显著差异（P < 0.001）。多变量逻辑回归分析确定膀胱内前列腺突入（IPP）、前列腺尿道角（PUA）和preop-BNT是影响术后结果一致性的独立因素。在经前列腺MRI和尿动力学检查确诊为术后存在残余梗阻的51例PBNO患者中，多变量逻辑回归分析显示preop-BNT是独立危险因素，PUA是独立保护因素。ROC分析确定预测残余梗阻的最佳preop-BNT临界值为7.50 mm。
在许多此类前列腺体积较小的BPH患者中，PBNO导致术后客观评估与主观评估改善之间存在显著差异。术前BNT是指导这些患者手术决策的重要指标。测量BNT有助于在前列腺解剖性剜除术（AEEP）中决定是否保留或切开膀胱颈，从而获得更好的术后效果。
