尿道压力描记检查在人工尿道括约肌植入术中的应用

Application of urethral pressure profilometry in artificial urinary sphincter implantation

目的应用尿道压力描记检查探讨人工尿道括约肌(AUS)植入术前后最大尿道压(MUP)及最大尿道闭合压(MUCP)的变化情况及预后价值。方法回顾性分析自2019年3至7月在多家医院接受AUS植入术的患者的临床资料。收集患者术前、术中尿道压力描记检查结果、尿垫使用量、相关评分及手术相关并发症出现情况,并比较其差异。研究终点是激活控制泵后1个月的控尿情况。结果共5例患者纳入研究,且均为男性。其中2例因前列腺增生接受经尿道前列腺电切术,2例因前列腺癌接受前列腺癌根治术,1例因车祸伤接受尿道会师术、尿道狭窄扩张术及膀胱造瘘术;所有患者就诊时均存在不同程度尿失禁。患者年龄61~84岁(平均72.6岁)。术前尿道压检测示5例患者的MUP分别为52、53、88、32、66 cmH2O(1 cmH2O=0.098 kPa),MUCP分别为17、52、62、27、40 cmH2O。行AUS植入术,术中尿道压检测示失活状态下MUP分别为53、113、50、77、89 cmH2O,MUCP分别为50、97、31、71、51 cmH2O;激活状态下MUP分别为112、174、193、121、120 cmH2O,MUCP分别为109、160、175、114、92 cmH2O。术后6周所有患者均成功激活控制泵,激活控制泵后1个月电话随访,所有患者均达到社交控尿(0~1块尿垫/d)标准。截至随访时未发生手术相关并发症。结论通过测量AUS植入术中MUP及MUCP的具体数值,并与控尿效果对比,可以得到术中尿道压范围与控尿效果之间的关系,从而为AUS植入术疗效评估提供数据化依据。

Objective To investigate the changes of maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)after artificial urethral sphincter(AUS)implantation and their prognostic value.Methods The clinical data of patients who had undergone AUS implantation in multiple medical centers between March and July 2019 were retrospectively analyzed.Data of urethral pressure profilometry,pad usage,related scores and complications related to surgery were collected and compared.The primary endpoint was social continence(defined as 0-1 pad/d)1 month after activation of the pump.Results A total of five male patients were included in this study.Two underwent transurethral resection of the prostate for benign prostatic hyperplasia,two underwent radical prostatectomy for prostate cancer,and one underwent urethral reunion,urethral stricture dilatation and cystostomy due to trauma from traffic accident.All patients had different degrees of urinary incontinence.The results of preoperative urethral profilometry test showed that the MUP of five patients were 52,53,88,32,and 66 cmH2O(1 cmH2O=0.098 kPa),respectively,and the MUCP were 17,52,62,27,and 40 cmH2O,respectively.AUS implantation was performed.The intraoperative urethral pressure profilometry showed that the MUP were 53,113,50,77,and 89 cmH2O in the inactivated state,and the MUCP were 50,97,31,71,and 51 cmH2O,respectively.In the activated state,the MUP were 112,174,193,121,and 120 cmH2O,and the MUCP were 109,160,175,114,and 92 cmH2O,respectively.All patients met the social continence(0-1 pad/d)criterion.No complications were reported during the follow-up.Conclusions The relationship between the range of intraoperative urethral pressure and the effect of urinary control can be gained by measuring the specific values of MUP and MUCP during AUS implantation and the post-operative effects,which provides as a data basis for standardizing AUS implantation.