Background: We investigated the predictive role of prostatic morphology on preoperative multiparametric magnetic resonance imaging for post-prostatectomy urinary incontinence.Methods: Patients who underwent robot-assisted radical prostatectomy between February 2018 and October 2021 and who were not previously incontinent, did not undergo radiotherapy, hormone therapy, or transurethral resection of the prostate, and who had a follow-up longer than 12 months were selected. For each patient, a radiology physician evaluated the preoperative magnetic resonance imaging, measuring prostatic and membranous urethral length, classifying prostatic apex according to the Lee Type, and estimating the presence of the median lobe and its intravesical protrusion. Multivariate logistic regression models evaluated the influence of anatomic features measured in magnetic resonance imaging on urinary continence recovery, defined as daily pad usage less than or equal to one, considering age, body mass index, prostate volume, International Prostatic Symptoms Score, the usage of a nerve sparing technique, and the International Society of Urological Pathology classification.Results: A total of 95 patients who underwent robot-assisted radical prostatectomy were enrolled. Median age, median body mass index, and median PSA density were respectively 66 years (62, 70), 26.12 kg/m2(23.88, 28.09), and 0.16 ng/mL/cc (0.10, 0.26). Patients with urinary continence ranged from 32 (33.7%) at baseline to 93 (97.8%) after one year from surgery. At preoperative magnetic resonance, Lee Type was almost equally distributed, but Type C was less represented (18 patients, 18.9%) and Type D was more frequent (31 patients, 32.2%). Median prostatic urethral length, median membranous urethral length, and median intravesical prostatic protrusion were respectively 36 mm (31, 42), 15 mm (13, 16), and 0 mm (0, 0). Multivariate logistic regression models showed no statistical significance, except for Lee Type C and A comparison at vesical catheter removal after surgery (OR 0.17; 95% CI 0.04–0.71;p-value 0.01).Conclusions: The results of this study showed that patients who had Lee Type C might have higher probability of early urinary continence recovery, but no further statistically significant correlations were found.
背景：本研究旨在探讨术前多参数磁共振成像中前列腺形态学特征对前列腺切除术后尿失禁的预测作用。方法：选取2018年2月至2021年10月期间接受机器人辅助根治性前列腺切除术、术前无尿失禁史、未接受放疗、激素治疗或经尿道前列腺切除术、且随访时间超过12个月的患者。由放射科医师评估每位患者的术前磁共振影像，测量前列腺长度和膜部尿道长度，根据Lee分型对前列腺尖部进行分类，并评估中叶存在情况及其膀胱内突出程度。在控制年龄、体重指数、前列腺体积、国际前列腺症状评分、神经保留技术应用及国际泌尿病理学会分级等变量后，采用多变量逻辑回归模型分析磁共振成像解剖特征对尿控恢复（定义为每日护垫使用量≤1片）的影响。结果：共纳入95例接受机器人辅助根治性前列腺切除术的患者。中位年龄、中位体重指数和中位PSA密度分别为66岁（62，70）、26.12 kg/m²（23.88，28.09）和0.16 ng/mL/cc（0.10，0.26）。尿控恢复患者比例从基线时的32例（33.7%）上升至术后一年的93例（97.8%）。术前磁共振显示Lee分型分布基本均衡，但C型较少（18例，18.9%），D型较多（31例，32.2%）。中位前列腺尿道长度、中位膜部尿道长度和中位膀胱内前列腺突出分别为36 mm（31，42）、15 mm（13，16）和0 mm（0，0）。多变量逻辑回归模型显示，除术后拔除导尿管时Lee C型与A型的比较具有统计学意义（OR 0.17；95% CI 0.04–0.71；p值0.01）外，其余指标均无显著相关性。结论：本研究结果表明，Lee C型患者可能具有更高的早期尿控恢复概率，但未发现其他具有统计学意义的显著相关性。
Preoperative MRI Predictors for Post-Prostatectomy Urinary Incontinence
肿瘤(癌症)患者之家