Pre-operative Prostate MRI Predictors of Social Continence following Radical Prostatectomy
[article]
Hannah Lamberg, University, My, Matthew Davenport
2021
Statement Membranous urethra length (MUL) on pre-operative prostate magnetic resonance imaging (MRI) is a signifi cant predictor of social continence after radical prostatectomy (RP) both in univariate and multivariate logistic regression models, while the other MRI measures evaluated were not. Inter-rater agreement of the measure is stronger after measure-specifi c radiologist training. Background Urinary continence after radical prostatectomy (RP) has a large impact on patient quality of
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... Many clinical variables and measures on prostate magnetic resonance imaging (MRI) have been associated with continence outcomes, though the effect size and role in routine clinical practice is still unclear 1-5 . Purpose To evaluate the inclusion of MRI-based anatomic prostate measures in multivariable models used to predict social continence post-RP and to determine the interrater agreement of these anatomic measures. Methods In this retrospective study, we evaluated continence outcomes in adult men who had prospectively reported continence data available (EPIC-26) and underwent RP at one quaternary care medical center. MRI-based anatomic measures were obtained retrospectively, by 4 trained abdominal radiologists, from each subject's pre-operative prostate MRI. Logistical regression models were developed at 3-, 6-, and 12-months post-RP with clinical variables alone, MRI variables alone, and combined clinical and MRI variables at each time point. Interrater agreement of measurements amongst radiologists was assessed using intraclass correlation coeffi cients. Results 589 subjects were included, with subsets of the entire population used in each multivariable model depending on continence data availability. In all models, coronal MUL had a statistically signifi cant odds ratio (OR) less than 1 (OR 0.79-0.89), indicating that a longer pre-operative MUL confers decreased risk for post-RP social incontinence. No other MRI variables (inner levator distance, outer levator distance, pubourethral angle, prostate volume, PIRADS score, median lobe size, and angle between membranous urethra and prostatic axis) were found to be signifi cant across all time points. Age and urinary function baseline score were the only signifi cant clinical variables at every time point. Combined clinical and MRI variable models had better discriminatory ability than the clinical-only or MRI-only models at each time point, but these differences were not statistically signifi cant. We also found improved interrater agreement for coronal MUL among our trained readers (ICC=0.620) compared to agreement between the trained readers and the original clinical measurements (ICC=0.382). Conclusions Pre-operative coronal MUL is a valuable predictor of post-RP social continence. Our data supports the use of combined MRI and clinical variables to predict continence outcomes in this population. Interrater agreement is best among abdominal radiologists with measure-specifi c training. Von Bodman C, Matsushita K, Savage C, et al. Recovery of urinary function after radical prostatectomy: Predictors of urinary function on preoperative prostate magnetic resonance imaging. J Urol. 2012;187(3):945-950. 4. Mendoza PJ, Stern JM, Li AY, et al. Pelvic anatomy on preoperative magnetic resonance imaging can predict early continence after robot-assisted radical prostatectomy. J Endourol. 2011;25(1):51-55. doi:10.1089/end.2010.0184 5. Kim JJ, Ha YsS, Kim JH, et al. Independent predictors of recovery of continence 3 months after robot-assisted laparoscopic radical prostatectomy. J Endourol. 2012;26(10): Statistically insignificant variables in each model: MRI alone: inner LD, outer LD, aMUP, pubourethal angle, prostate volume, PIRADS score, median lobe size Clinical alone: BMI, initial PSA, grade groups 2/4/5 Combined: BMI, initial PSA, grade groups 2/4/5, Epic urinary baseline score, Epic sexual baseline score, inner LD, outer LD, aMUP, pubourethal angle, prostate volume, PIRADS 4 score, median lobe size Table 3 . Univariable and multi-variable analyses of social continence at 6 months post-radical prostatectomy. Odds ratios below '1' indicate a lesser risk of incontinence. Reference for PI-RADS scores is PI-RADS 3. Reference for grade group is grade group 1. Angle between membranous urethra and prostatic axis (aMUP).
doi:10.7302/3581
fatcat:6bxv2oasyveytng77em64sr7ly