ABSTRACT
CONDENSATION: A mathematical formula to estimate the levator ani subtended volume parameter based on magnetic resonance imaging linear measurements from one axial and one sagittal view. OBJECTIVE: To estimate the levator ani subtended volume based on MRI linear measurements. METHODS: The 3D Slicer was used to obtain the Levator Ani Subtended Volume (LASV) from 35 women with Pelvic Organ Prolapse (POP), that were assumed as reference values. The linear measurements that best fitted our criteria were chosen. The subjects were divided in two groups, 1 and 2. The coefficients of the mathematical equation were obtained from group 1 through a regression analysis using the 3D rendering volume as a dependent variable. To validate the mathematical equation, two observers, blinded to POP ordinal stages, performed new measurements. The 3D rendering and the estimated volumes were compared and correlated with POP-Q measurements and POP ordinal stages. A residual analysis was performed to validate the mathematical equation. Finally, a reliability analysis was performed. RESULTS: The predictors chosen were M-line, H-line, and width of levator hiatus. An equation to estimate the volume was determined: eLASV = -72.838 + 0.598H-line + 1.217M-line + 1.136WLH1. The estimated values showed similar correlation with POP-Q individual measurements and ordinal stages. The residual analysis showed normal distribution of the estimate values and the errors, from both observers. The intra and interclass evaluation of the estimated values indicated a good reliability of the eLASVs. CONCLUSION: The LASV can be estimated using well known Magnetic Resonance linear measurements, showing good correlation with correspondent 3D rendering volumes. The clinical relevance of this parameter should be proved in further studies.
Subject(s)
Image Interpretation, Computer-Assisted/methods , Magnetic Resonance Imaging , Models, Theoretical , Pelvic Floor/diagnostic imaging , Pelvic Organ Prolapse/diagnostic imaging , Anatomic Landmarks , Female , Humans , Imaging, Three-Dimensional , Observer Variation , Predictive Value of Tests , Prognosis , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , SoftwareABSTRACT
INTRODUCTION: The treatment of benign prostate hyperplasia (BPH) presents 2 options: medical or surgical, and there are doubts about what is the best treatment since 80 percent of patients who undergo surgery become asymptomatic and 10 to 40 percent of those under medical regimen undergo surgery within a 5 years period. It is difficult to assess the actual costs of treating BPH in Brazil due to several factors, among them regional particularities and the scarcity of current statistical data. PATIENTS AND METHODS: Recently, in the Ribeirão Preto area, São Paulo, Brazil, the IPSS (International Prostatic Symptoms Score) and quality of life were verified in 934 volunteers. It was determined the percentage of individuals with ages ranging from 40 to 79 years with moderate symptoms (score 8-19) and with severe symptoms (score 20-35), values for which are indicated medical and surgical treatment, respectively, according to the Brazilian Society of Urology consensus on BPH. Data on Brazilian population in that age range were obtained from the Brazilian Institute of Geography and Statistics referent to the year of 2000. It was determined the number of patients, according to the criteria above, subjected to either one of the treatments mentioned. Surgical costs of prostate transurethral resection were researched according to Unified Health System - SUS tables (US$ 173) and of Brazilian Medical Society - AMB with a mean cost in 3 hospitals of US$ 933. Drug costs were calculated by the annual mean price (US$ 355) of 4 alpha-blockers (tamsulosin, alfuzosin, doxazosin and terazosin). RESULTS: The estimated population for medical treatment was 5,397,321 individuals, with a cost corresponding to US$ 1,916,489,055.00. The estimated population for surgical treatment was 2,040,299 men, what would represent a cost of US$ 353,291,204.00 based on the SUS table and of US$ 1,904,279,066.00 based on AMB with hospital expenses included. CONCLUSION: All theses facts induce us to predict that the treatment of BPH in a not-so-far future can become a public health problem for Brazilian society, since the current estimate would be, approximately, costs around 2.26 - 3.83 billion dollars, added by the yearly increase in the risk population (24.99 percent) for the group under medical treatment and over the non-operated amount of the surgical group.
