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Inter-observer variability in male pelvic-floor MRI measurements that might predict post-prostatectomy incontinence

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Abstract

Introduction

Current studies are focusing on the relationship between anatomical variables in preoperative prostate MRI and the development of post-prostatectomy incontinence (PPI). Nevertheless, there is little evidence regarding the reliability of these measurements. The objective of this study was to analyze the concordance between urologists and radiologists for anatomical measurements that might be PPI predictors.

Material and methods

Pelvic floor measurements with 3T-MRI were performed by two radiologists and two urologists independently and blindly. Interobserver agreement was determined using the intraclass correlation coefficient (ICC) and the Bland–Altman plot.

Results

The concordance was good-acceptable for most measurements, except for the levator ani and puborectalis muscle thickness (some ICC values  < 0.20/p value > 0.05). The anatomical parameters with the highest degree of agreement were intravesical prostatic protrusion (IPP) and prostate volume (most of the ICC values > 0.60). The membranous urethral length (MUL) and the angle of the membranous urethra-prostate axis (aLUMP) presented ICC > 0.40. The obturator internus muscle thickness (OIT), urethral width and intraprostatic urethral length presented a fair-moderate degree of agreement (ICC > 0.20). Regarding the agreement between different specialists, the highest degree was obtained for the two radiologists and for urologist 1-radiologist 2 (moderate median agreement), while urologist 2 with each of the radiologists had a regular median agreement.

Conclusions

MUL, IPP, prostate volume, aLUMP, OIT, urethral width and prostatic length show acceptable inter-observer concordance and they would be reliable as possible predictors of PPI. Levator ani and puborectalis muscle thickness show bad agreement. Interobserver agreement might not be greatly influenced by previous professional experience.

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Data Availability

Interobserver agreement was moderate between radiologists and fair-moderate betweent urologists and radiologists.

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Funding

This research was not funded.

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Authors and Affiliations

  1. Urology Department, Hospital Universitario Virgen del Rocío, Seville, Spain

    Carmen Muñoz-Calahorro, Cristina García-Sánchez & Rafael Antonio Medina-López

  2. Radiology Department, Hospital Universitario Virgen del Rocío, Seville, Spain

    Mariano José Parada-Blázquez & Leticia López-Arellano

  3. Faculty of Medicina, University of Seville, Seville, Spain

    Pilar Vizcaíno-Velázquez

Authors
  1. Carmen Muñoz-Calahorro
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  2. Mariano José Parada-Blázquez
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  3. Cristina García-Sánchez
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  4. Leticia López-Arellano
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  5. Pilar Vizcaíno-Velázquez
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  6. Rafael Antonio Medina-López
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Contributions

GSC contributed to project development, data collection or management, manuscript writing/editing. LAL contributed to data collection or management. MLRA contributed to project development and manuscript writing/editing. MCC contributed to project development, data collection or management, data analysis, manuscript writing/editing. PBMJ contributed to data collection or management. VVP contributed to data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Carmen Muñoz-Calahorro.

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None of the contributing authors have any conflicts of interest.

Human and animal rights

This research involved human participants. This study was approved by the ethical review board of Hospital Virgen del Rocío-Virgen Macarena. Principles of Helsinki Declaration were followed in lieu of formal ethics committee approval.

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Muñoz-Calahorro, C., Parada-Blázquez, M.J., García-Sánchez, C. et al. Inter-observer variability in male pelvic-floor MRI measurements that might predict post-prostatectomy incontinence. World J Urol 41, 1147–1155 (2023). https://doi.org/10.1007/s00345-023-04320-3

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  • DOI: https://doi.org/10.1007/s00345-023-04320-3

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