Ressonância magnética dinâmica de uretra: uma nova técnica no planejamento e seguimento a médio e longo prazo da uretroplastia pós-prostatectomia radical
Data
2024-03-21
Orientadores
Goldman, Suzan Menasce 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Avaliar o impacto da ressonância magnética dinâmica de uretra (RMU-D) nos resultados pós-operatórios de uretroplastia em pacientes com diagnóstico de estenose de uretra pós-prostatectomia radical, e avaliar a concordância da RMU-D com os resultados transoperatórios desses pacientes. Métodos: Um total de 48 pacientes (idade média: 65,2 ± 8,1 anos) com estenose de anastomose vesicouretral pós-prostatectomia radical submetidos a uretroplastia utilizando RMU-D e uretrocistrografia (UCG) como método de escolha na avaliação da estenose e planejamento cirúrgico para reconstrução uretral foram acompanhados prospectivamente de janeiro de 2018 a junho de 2023. Os pacientes foram divididos em dois grupos de acordo com o método: RMU-D e UCG. Os pacientes do grupo RMU-D realizaram o novo protocolo de imagem por ressonância magnética: enchimento uretral com lidocaína gel e obstrução uretral com torniquete de gaze estéril. Uretrograma por ressonância em T1 axial, coronal space, sagital T2, T2 axial, sagital MIP, com efeito urográfico, sagital miccional MIP, T1 fat-sat antes e após o gadolínio. A aquisição dinâmica durante o esforço miccional com imagens em movimento foi também realizada. Resultados: Não houve diferença entre o grupo RMU-D e UCG em relação à reestenose (5,6% vs. 16,7%, respectivamente, p=0.261). Quando comparados quanto à preservação vascular, o grupo da RMU-D apresentou diferença estatisticamente significante em relação ao grupo UCG (94,4% vs. 63,3%, respectivamente, p=0,016). As medidas de estenose na RMU-D foram concordantes com as medidas transoperatórias. Os valores do coeficiente de correlação intraclasse demonstraram que a força da concordância variou de satisfatória a excelente entre os dois métodos e uma forte correlação entre as medidas na RMU-D com as das transoperatórias, com viés de concordância bem próximo de zero pelo método de Bland-Altman. Conclusões: A RMU-D apresentou maior taxa de preservação vascular e suas medidas de estenose concordaram com os resultados transoperatórios.
Objective: To evaluate the impact of dynamic magnetic resonance imaging of the urethra (D-MRI) on the postoperative results of urethroplasty in patients diagnosed with post-radical prostatectomy urethral stricture, and to evaluate the agreement of D-MRI and the intraoperative results of these patients. Methods: 48 patients (mean age: 65.2 ± 8.1 years) with stenosis of the urethrovesical anastomosis after radical prostatectomy, confirmed by cystoscopy, were submitted to an evaluation with D-MRI and urethrocystography (UCG). Patients were divided into two groups according to the method: D-MRI and UCG. The patients from D-MRI group were submitted to the same new exam protocol: urethral filling with lidocaine gel and distal urethral obstruction with tourniquet sterile gases, MRI urethrogram in T1 axial, coronal space, sagittal T2, T2 axial, sagittal MIP with urographic effect, voiding sagittal MIP, T1 fat-sat before and after gadolinium. A dynamic acquisition during the voiding effort with moving images was also performed. Results: There was no difference between D-MRI and UCG groups in relation to restenosis (5.6% vs. 16.7%, respectively, p=0.261). When compared regarding vascular preservation, D-MRI group presented a statistically significant difference in relation to UCG group (94.4% vs 63.3%, respectively, p=0.016). The stenosis measurements obtained from D-MRI were found to be consistent with the transoperative measurements. The intraclass correlation coefficient values revealed that there was a satisfactory to excellent level of agreement between the two methods, and there existed a strong correlation between the measurements obtained from the D-MRI and those obtained from the transoperative methods. Additionally, the Bland-Altman method revealed that the agreement bias was almost zero. Conclusions: D-MRI showed a higher rate of vascular preservation and its stenosis measurements agreed with the intraoperative results.
Objective: To evaluate the impact of dynamic magnetic resonance imaging of the urethra (D-MRI) on the postoperative results of urethroplasty in patients diagnosed with post-radical prostatectomy urethral stricture, and to evaluate the agreement of D-MRI and the intraoperative results of these patients. Methods: 48 patients (mean age: 65.2 ± 8.1 years) with stenosis of the urethrovesical anastomosis after radical prostatectomy, confirmed by cystoscopy, were submitted to an evaluation with D-MRI and urethrocystography (UCG). Patients were divided into two groups according to the method: D-MRI and UCG. The patients from D-MRI group were submitted to the same new exam protocol: urethral filling with lidocaine gel and distal urethral obstruction with tourniquet sterile gases, MRI urethrogram in T1 axial, coronal space, sagittal T2, T2 axial, sagittal MIP with urographic effect, voiding sagittal MIP, T1 fat-sat before and after gadolinium. A dynamic acquisition during the voiding effort with moving images was also performed. Results: There was no difference between D-MRI and UCG groups in relation to restenosis (5.6% vs. 16.7%, respectively, p=0.261). When compared regarding vascular preservation, D-MRI group presented a statistically significant difference in relation to UCG group (94.4% vs 63.3%, respectively, p=0.016). The stenosis measurements obtained from D-MRI were found to be consistent with the transoperative measurements. The intraclass correlation coefficient values revealed that there was a satisfactory to excellent level of agreement between the two methods, and there existed a strong correlation between the measurements obtained from the D-MRI and those obtained from the transoperative methods. Additionally, the Bland-Altman method revealed that the agreement bias was almost zero. Conclusions: D-MRI showed a higher rate of vascular preservation and its stenosis measurements agreed with the intraoperative results.
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Citação
FIEDLER, Gustavo. Ressonância magnética dinâmica de uretra: uma nova técnica no planejamento e seguimento a médio e longo prazo da uretroplastia pós-prostatectomia radical. 2024. Tese (Doutorado em Radiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.