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MRI and MR voiding cystourethrography in the evaluation of male primary bladder neck obstruction: preliminary experience

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Abstract

Purpose

Evaluation of male with primary bladder neck obstruction (PBNO) using MRI and MR voiding cystourethrography (MR-VCU) to study both anatomical aspects of bladder neck and urethral lumen.

Methods

In this retrospective study 21 male patients (mean age 33 ± 14) with urodynamic diagnosis of PBNO and 5 healthy volunteers ((mean age 28 ± 2) as control group were enrolled. Both patients and control group underwent 1.5 T MRI. Sagittal and oblique coronal Turbo-Spin-Echo T2-weighted scans were performed. Only patients underwent MR voiding cystourethrography (MR-VCU) performed with T1-weighted spoiled 3D gradient-echo sagittal acquisitions. Bladder lumen was filled with contrast-material-enhanced urine. Blinded test by two radiologists was performed to evaluate causes of bladder outlet obstruction evaluating MR-VCU. Anatomical MRI features of both control group and patients were compared in consensus by senior radiologist and urologist using the analysis of variance (ANOVA) test.

Results

MRI allowed evaluation of the bladder neck muscular structures. We found 4 groups of PBNO patients: 52% hypertrophy of posterior lip of bladder sphincter; 20% asymmetry of lateral portion of bladder sphincter; 14% bladder neck cyst; 14% showed normal aspect of bladder neck. Comparison between the control group and first and second PBNO groups was considered statistically significant (p < 0.05) with diagnostic accuracy of 87%. Only 13 patients (61%) were able to perform MR-VCU and radiologists always made the diagnosis of PBNO.

Conclusion

MRI together with MR-VCU provides useful anatomical and functional information in the study of bladder neck and urethral lumen. These preliminary results suggest that MRI could substitute for standard cystourethrogram in patients with PBNO.

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Abbreviations

PBNO:

Primary bladder neck obstruction

MR-VCU:

MR voiding cystourethrography

VUD:

Video-urodynamic

ANOVA:

Analysis of variance

PVR:

Post-void residual

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Acknowledgements

The authors would like to thank Prof. James Marsh Sternberg, M.D., for some valuable suggestions for this manuscript, Dr. Francesco Dellepiane, M.D., Giovanni Benvenuti, M.D. and Giacomo Maccagno, M.D. for the help in patients’ recruitment and Prof. Paolo Di Girolamo, PhD, for the help in the statistical analysis.

Funding

The authors state that this work has not received any founding.

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Authors and Affiliations

  1. Department of Radiology, Sant’Andrea Hospital Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy

    Marco Di Girolamo, Giulia Marta Barelli, Elisa Rosati & Andrea Laghi

  2. Department of Urology, Clinica Madonna Delle Grazie, Velletri, Rome, Italy

    Simone Mariani

  3. Department of Urology, Sant’Andrea Hospital Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy

    Alberto Trucchi

Authors
  1. Marco Di Girolamo
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  3. Giulia Marta Barelli
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  4. Elisa Rosati
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  6. Andrea Laghi
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Contributions

MDG: substantial contributions to the conception and design of the study; acquisition, analysis, and interpretation of the data; drafting the article and revision; final approval of the version to be published. SM: substantial contributions to the conception and design of the study; drafting the article and revision; final approval of the version to be published. GMB: acquisition, analysis, and interpretation of the data; final approval of the version to be published. ER: acquisition, analysis, and interpretation of the data; final approval of the version to be published. AT: substantial contributions to the conception and design of the study; final approval of the version to be published. AL: drafting the article and revision; final approval of the version to be published. Statistics and biometry: Prof. PDG, PhD, kindly provided statistical advice for this manuscript.

Corresponding author

Correspondence to Marco Di Girolamo.

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Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the manuscript. All the authors have nothing to disclose concerning potential conflicts (financial, professional, or personal) that are relevant to the manuscript.

Guarantor

The scientific guarantor of this publication is Prof. Andrea Laghi, Full Professor of Radiology. Faculty of Medicine and Psychology, Sapienza University of Rome.

Informed consent

Written and informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained (Prot. CE n.249/2013).

Study subjects or cohorts overlap

The study subjects were based of Adults and no study subjects or cohorts have been previously reported.

Methodology

Retrospective study; Case–Control Study; The study was performed at one Institution.

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Di Girolamo, M., Mariani, S., Barelli, G.M. et al. MRI and MR voiding cystourethrography in the evaluation of male primary bladder neck obstruction: preliminary experience. Abdom Radiol 47, 746–756 (2022). https://doi.org/10.1007/s00261-021-03362-8

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