AbstractThis study aimed to construct a novel pelvis-prostate model BPPP which consists of body mass index (BMI), prostate volume (PV), pelvic cavity index (PCI) and prostate-muscle index (PMI) to predict the immediate urinary continence after Retzius-sparing robot assisted laparoscopic radical prostatectomy (RS-RARP).

摘要本研究旨在构建一种由体重指数（BMI），前列腺体积（PV），盆腔指数（PCI）和前列腺肌肉指数（PMI）组成的新型骨盆前列腺模型BPPP，以预测保留Retzius机器人辅助腹腔镜根治性前列腺切除术（RS-RARP）后的即时尿失禁。

The perioperative data of patients with prostate cancer who underwent RS-RARP in the department of urology of Nanjing Drum Tower Hospital from June 2018 to June 2022 were retrospectively analyzed. 280 patients were eligible for this study in total. Multivariate analysis showed that BMI, PV, PCI, PMI and NVB preservation were significantly associated with immediate urinary continence after RS-RARP.

回顾性分析2018年6月至2022年6月南京鼓楼医院泌尿外科接受RS-RARP治疗的前列腺癌患者的围手术期资料。总共有280名患者有资格参加这项研究。多变量分析显示，RS-RARP后BMI，PV，PCI，PMI和NVB保留与即时尿失禁显着相关。

Subgroup analysis showed that patients with low BMI, low PV, high PCI and high PMI had a higher recovery rate of immediate urinary continence. The area under the curve of BPPP (BMI + PV + PCI + PMI) for predicting the immediate recovery of urinary continence after RS-RARP was 0.726. Delong test showed that the area under the curve of the combined test for predicting the immediate urinary continence after RS-RARP was better compared with single parameter (p < 0.05).

亚组分析显示，低BMI，低PV，高PCI和高PMI的患者立即尿失禁的恢复率较高。用于预测RS-RARP后尿失禁立即恢复的BPPP曲线下面积（BMI++PV++PCI++PMI）为0.726。德隆检验显示，与单参数相比，预测RS-RARP术后即刻尿失禁的联合检验曲线下面积更好（p<0.05）。

In conclusion the novel pelvis-prostate model BPPP may predict the immediate urinary continence after RS-RARP, providing information for preoperative decision-making..

总之，新型骨盆前列腺模型BPPP可以预测RS-RARP术后即刻尿失禁，为术前决策提供信息。。

IntroductionProstate cancer (PCa) is the most common malignant tumor in the male urinary system. In the world, prostate cancer is the second most common male malignant tumor. The incidence and mortality of prostate cancer in the United States are the first and sixth among all male malignant tumors, respectively1.Radical prostatectomy is the gold standard for the treatment of localized prostate cancer2.

简介前列腺癌（PCa）是男性泌尿系统中最常见的恶性肿瘤。前列腺癌是世界上第二常见的男性恶性肿瘤。在所有男性恶性肿瘤中，美国前列腺癌的发病率和死亡率分别为第一和第六。根治性前列腺切除术是治疗局限性前列腺癌的金标准2。

The advent of robotic surgical systems had a significant impact on every surgical area, especially urology. Various robot platforms, including daVinci®, continuously improve work performance and reduce costs to adapt to various surgical environments3. With the introduction of robot assisted laparoscopic system, the surgical procedure for prostate cancer is gradually transitioning to robot assisted radical prostatectomy (RARP)4.

机器人手术系统的出现对每个手术领域都产生了重大影响，尤其是泌尿外科。包括达芬奇®在内的各种机器人平台不断提高工作性能并降低成本，以适应各种手术环境3。随着机器人辅助腹腔镜系统的引入，前列腺癌的外科手术逐渐过渡到机器人辅助根治性前列腺切除术（RARP）4。

This operation has many advantages, such as three-dimensional magnification of the anatomical structure of the pelvis and prostate, the use of mechanical arm to improve the flexibility of operation, and the accuracy of suture and knot5. However, the randomized controlled study conducted by Coughlin et al.

这种手术具有许多优点，例如骨盆和前列腺解剖结构的三维放大，使用机械臂来提高手术的灵活性，以及缝合和打结的准确性5。然而，Coughlin等人进行的随机对照研究。

compared the traditional open retropubic prostatectomy with robot assisted radical prostatectomy, showing that there was no significant difference in the recovery of postoperative urinary continence and erectile function 2 years after operation6. In 2010, galfano team first carried out the Retzius-sparing robot assisted radical prostatectomy (RS-RARP) to complete the prostatectomy from the posterior approach through the rectovesical space7.

将传统的开放式耻骨后前列腺切除术与机器人辅助的根治性前列腺切除术进行比较，结果显示术后2年尿失禁和勃起功能的恢复无显着差异6。2010年，galfano团队首次进行了保留Retzius的机器人辅助根治性前列腺切除术（RS-RARP），以完成从后入路到直肠膀胱间隙的前列腺切除术7。

Compared with the traditional approach, this operation does not need to open the Retzius space, and protects the pelvic fascia, puboprostatic ligament, accessory pudendal artery, Santorini nerve and other struc.

与传统入路相比，该手术不需要打开Retzius间隙，保护骨盆筋膜、耻骨前列腺韧带、阴部副动脉、圣托里尼神经等结构。

(1)

(1)

Prostate biopsy and postoperative pathology were confirmed as prostate cancer, and the preoperative Gleason score and postoperative pathological Gleason score were less than or equal to 8 points (including 3 + 3, 3 + 4, 4 + 3, 4 + 4 + 3 + 5);

前列腺活检和术后病理证实为前列腺癌症，术前Gleason评分和术后病变Gleason得分均小于等于8分

(2)

(2)

The pelvis or prostate were examined by multi parameter magnetic resonance imaging before operation;

术前用多参数磁共振成像检查骨盆或前列腺；

(3)

(3)

The clinical baseline data and imaging data of the patients were evaluated by surgeon and an experienced radiologist. The tumor was localized, and the preoperative TMN staging was within T2C, without regional lymph node metastasis or distant metastasis; AJCC prognosis group was grouped in IIIA stage;.

外科医生和经验丰富的放射科医生评估了患者的临床基线数据和影像学数据。肿瘤定位，术前TMN分期在T2C内，无区域淋巴结转移或远处转移；AJCC预后组分为IIIA期；。

(4)

(4)

Patients were generally in good condition, without serious underlying diseases, and could tolerate surgery;

患者一般状况良好，没有严重的基础疾病，可以耐受手术；

(5)

(5)

Patients were followed up by the prostate cancer postoperative follow-up center. The follow-up data were complete, and the follow-up time was ≥ 6 months.

前列腺癌术后随访中心对患者进行随访。随访数据完整，随访时间≥6个月。

Exclusion criteria:

排除标准：

(1)

(1)

The preoperative imaging stage of patients was > T2C or recurrent and metastatic cancer;

患者的术前影像学分期为T2C或复发和转移性癌症；

(2)

(2)

Patients had severe lower urinary tract symptoms before operation and had a history of catheter or previous TURP operation;

患者术前有严重的下尿路症状，有导管史或既往TURP手术史；

(3)

(3)

Patients received hormone therapy or radiotherapy before operation;

患者术前接受激素治疗或放疗；

(4)

(4)

Patients had history of abdominal trauma or surgery;

患者有腹部创伤或手术史；

(5)

(5)

Patients were complicated with other malignant tumors;

患者并发其他恶性肿瘤；

(6)

(6)

Patients were converted to open surgery or complicated with severe postoperative complications;

患者转为开放手术或伴有严重的术后并发症；

(7)

(7)

Patients had delayed catheter removal (> 14 days);

患者延迟拔除导管（>14天）；

(8)

(8)

The patients’ clinical, imaging and pathological data were incomplete or the follow-up was lost;

患者的临床，影像学和病理学数据不完整或失访；

(9)

(9)

The compliance of postoperative functional training was poor, and the reliability of follow-up was low.

术后功能训练依从性差，随访可靠性低。

A total of 280 cases meeting the above inclusion and exclusion criteria were finally included.We collected perioperative data of patients: age, body mass index (BMI), BMI = weight/height2 (kg/m2), preoperative serum prostate specific antigen (PSA), prostate biopsy and postoperative pathological Gleason score, TNM staging (NCCN guideline 2022.4), AJCC prognosis group staging, intraoperative blood loss and console time, hospitalization time (total time from admission to discharge), positive surgical margin, NVB preservation during operation.MRI imaging and pelvimetry measurementsPreoperative multi parameter MRI 3.0 T prostate scan or pelvic scan measurement parameters (Figs. 1, 2, 3 and 4):$${\text{Prostate}}\;{\text{volume}}\left( {{\text{PV}}} \right):{\text{ prostate}}\;{\text{width}} \times {\text{length}} \times {\text{height}} \times \left( {\pi /6} \right);$$Figure 1Sagittal MRI on T2WI showing the important organs and anatomical markers during RS-RARP.

最终纳入了280例符合上述纳入和排除标准的病例。我们收集了患者的围手术期数据：年龄，体重指数（BMI），BMI=体重/身高2（kg/m2），术前血清前列腺特异性抗原（PSA），前列腺活检和术后病理Gleason评分，TNM分期（NCCN指南2022.4），AJCC预后组分期，术中失血量和控制时间，住院时间（从入院到出院的总时间），手术切缘阳性，术中NVB保存。MRI成像和骨盆测量术前多参数MRI 3.0 T前列腺扫描或骨盆扫描测量参数（图1,2,3和4）：$${\ text{前列腺}}；{\text{volume}}\左（{\text{PV}}\右）：{\text{prostate}}\；{\ text{width}\ times{\ text{length}\ times{\ text{height}\ times \ left（{\ pi/6}\ right）$$图1 T2WI上的矢状MRI显示RS-RARP期间的重要器官和解剖标记。

Bl, bladder; Bo, bowel; Pr, prostate; Pu, pubis; Sp, sacral promontory.Full size imageFigure 2Sagittal MRI on T2WI showing the pelvic cavity. (A) (Pelvic Inlet Diameter) defined as distance from the innermost aspect of the superior of the symphysis pubis to the sacral promontory. (B) (Pelvic Depth) defined as distance from the innermost aspect of the inferior of the symphysis pubis to the sacral promontory.

Bl，膀胱；Bo，肠；Pr，前列腺；Pu，耻骨；Sp，骶骨海角。全尺寸图像图2 T2WI上的矢状MRI显示盆腔。（A） （骨盆入口直径）定义为从耻骨联合上部最内侧到骶骨岬的距离。（B） （骨盆深度）定义为从耻骨联合下方最内侧到骶骨岬的距离。

(C) (Apex Depth) defined as orthogonal distance from top of symphysis pubis to apex of prostate. ∠α (Symphysis angle): defined as angle between the long axis of the symphysis pubis and the horizontal.Full size imageFigure 3Axial MRI on T2WI showing the Pelvic Outlet Diameter (D) which defined as distance between the tips of the ischial spines.Full size imageFigure 4Axial section of MRI on T2 showing the maximum a.

（C） （顶点深度）定义为从耻骨联合顶部到前列腺顶点的正交距离。∠α（联合角）：定义为耻骨联合长轴与水平轴之间的角度。全尺寸图像图3 T2WI上的轴向MRI显示骨盆出口直径（D），其定义为坐骨棘尖端之间的距离。全尺寸图像图4 T2上MRI的轴向切片显示最大a。

Data availability

数据可用性

The datasets generated and analysed during the current study are not publicly available since ongoing clinical studies based on the same database are on progress but are available from the corresponding author on reasonable request.

当前研究期间生成和分析的数据集尚未公开，因为基于同一数据库的正在进行的临床研究正在进行中，但可根据合理要求从通讯作者处获得。

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Download referencesFundingThe Sino-German Mobility Programme (M-0670), the Natural Science Foundation of Jiangsu Province (BE2020622), the National Natural Science Foundation of China (12174192).Author informationAuthors and AffiliationsDepartment of Urology, Nanjing Drum Tower Hospital, Affiliated Medical College of Nanjing University, Nanjing, 210008, ChinaXiaohu Zhang, Qing Zhang, Tianyi Chen, Hao Wang, Hongqian Guo & Gutian ZhangSchool of Medicine, Southeast University, Nanjing, ChinaXiaohu Zhang & Tianyi ChenInstitute of Urology, Nanjing University, Nanjing, ChinaQing Zhang & Hongqian GuoAuthorsXiaohu ZhangView author publicationsYou can also search for this author in.

下载参考资料资助中德流动计划（M-0670）、江苏省自然科学基金（BE2020622）、国家自然科学基金（12174192）。作者信息作者和附属机构南京大学附属医学院南京鼓楼医院泌尿外科，南京，210008，中国张晓虎，张清，陈天一，王浩，郭洪谦和张古田东南大学医学院，南京，张晓虎和陈天一南京大学泌尿外科研究所，南京，张清和郭洪谦作者张晓虎观点作者出版物你也可以在中搜索这位作者。

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PubMed Google ScholarContributionsG.Z., X.Z., Q.Z.: conception and design. H.W., T.C.: acquisition of data. X.Z., Q.Z: data analysis. X.Z.: drafting of the manuscript. H.G.: critical revision of the manuscript. X.Z., Q.Z.: statistical analysis. H.G, G.Z: obtaining funding. G.Z.: supervision.

PubMed谷歌学术贡献。Z、 ，X.Z.，Q.Z.：概念与设计。H、 W.，T.C.：数据采集。十、 Z.，Q.Z：数据分析。十、 Z.：起草手稿。H、 G.：稿件的批判性修订。十、 Z.，Q.Z.：统计分析。H、 G，G.Z：获得资金。G、 Z.：监督。

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Reprints and permissionsAbout this articleCite this articleZhang, X., Zhang, Q., Chen, T. et al. A novel pelvis-prostate model BPPP predicts immediate urinary continence after Retzius-sparing robotic-assisted laparoscopic radical prostatectomy.

转载和许可本文引用本文Zhang，X.，Zhang，Q.，Chen，T。等人。一种新型骨盆前列腺模型BPPP预测Retzius保留机器人辅助腹腔镜根治性前列腺切除术后立即尿失禁。

Sci Rep 14, 19271 (2024). https://doi.org/10.1038/s41598-024-70080-8Download citationReceived: 14 April 2024Accepted: 12 August 2024Published: 20 August 2024DOI: https://doi.org/10.1038/s41598-024-70080-8Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

科学报告1419271（2024）。https://doi.org/10.1038/s41598-024-70080-8Download引文接收日期：2024年4月14日接受日期：2024年8月12日发布日期：2024年8月20日OI：https://doi.org/10.1038/s41598-024-70080-8Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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