尿道压力描记检查结果与人工尿道括约肌植入术并发症的关系

Exploration of the relationship between the urethral pressure profilometry and the complications of artificial urethral sphincter implantation

目的探讨尿道压力描记检查结果与人工尿道括约肌(AUS)植入术并发症发生的关系。方法回顾性分析2019年3月至2022年3月15例于北京医院接受AUS植入术患者的临床资料。均为男性,年龄(68.6±13.2)岁。其中12例为前列腺癌术后,1例为车祸伤,2例为经尿道前列腺切除术后;病程11~120个月。尿垫使用数量中位值4.5(3.0,6.0)块。术前常规尿动力学检查示最大尿道压力(MUP)为(84.6±25.5)cmH_(2)O(1 cmH_(2)O=0.098kPa),最大尿道闭合压力(MUCP)为51.0(41.0,74.0)cmH_(2)O。所有患者均采用经会阴单切口完成AUS植入术,术中根据患者尿道周径选择袖套尺寸,安装所有组件后于装置失活及激活状态下行尿道压力描记检查,后失活装置。术后6周激活装置,记录激活装置3个月后的控尿情况及并发症发生情况等。分析尿道压力描记检查结果与并发症的关系。结果本研究患者采用的袖套周径:3例(20%)为4.0cm,10例(66.7%)为4.5cm,2例(13.3%)为5.0cm。AUS装置在术中失活状态下的MUP为(82.5±30.2)cmH_(2)O,MUCP为51.0(48.0,77.0)cmH_(2)O,较术前均无明显增加(P>0.05);术中激活状态下MUP为(138.9±21.7)cmH_(2)O,MUCP为109(94.0,133.0)cmH_(2)O,均较术前显著升高(P<0.001)。术后随访3~33个月,13例(86.7%)使用初次安装装置,且均达到社交控尿标准;1例因脑血管意外而死亡;1例因尿道侵蚀取出装置。术后并发症发生率为26.7%(4/15),其中无痛性血尿2例,阴囊阴茎感染1例(因未充分理解宣教指导,控制泵按压不彻底,导致慢性尿潴留、感染),尿道侵蚀1例。4例出现并发症的患者术中失活状态下MUP为(100.0±40.7)cmH_(2)O,MUCP为(80.8±39.7)cmH_(2)O;术中激活状态下MUP为(151.5±15.3)cmH_(2)O,MUCP为(123.0±17.2)cmH_(2)O。除1例感染患者外,其余3例在装置激活状态下的MUP均>150 cmH_(2)O。而无并发症发生的11例术中失活状态下MUP为(76.1±24.7)cmH_(2)O,MUCP为(55.1±20.0)cmH_(2)O;术中激活状态下MUP为(134.4±22.5)cmH_(2)O,MUCP为(108.5±29.8)cmH_(2)O,均低于出现并发症患者。结论AUS植入术中行尿道压力描记检查可能有助于预测并发症发生风险。装置在激活状态下的MUP高于150 cmH_(2)O、理解能力欠佳者可能更易出现并发症。

Objective To explore the potential relationship of urethral pressure profilometry and the complications of artificial urethral sphincter(AUS)implantation.Methods The clinical data of patients who underwent AUS implantation in Beijing Hospital from March 2019 to March 2022 were retrospectively analyzed.All the patients were male.The average course of disease was 43.1 months(ranging 11-120 months).The average age was(68.6±13.2)years.The median number of pads used was 4.5(3.0,6.0).The preoperative maximum urethral pressure(MUP)was(84.6±25.5)cmH_(2)O,and the maximum urethral closure pressure(MUCP)was 51.0(41.0,74.0)cmH_(2)O.AUS implantation was performed through a single perineal incision in all patients.The sleeve size was mainly determined by the measured urethral circumference of the patient.After installation of all components,the urethral pressure profilometry was performed under the state of device inactivation and activation.The pump was activated 6 weeks after the operation,and telephone follow-up was performed 3 months after the activation of the device.The urinary control and complications were recorded.The results of follow-up were compared with the results of urethral pressure profilometry,and the preliminary conclusions were drawn.Results In this study,3 patients(20%)received 4.0cm cuffs,10 patients(66.7%)received 4.5cm cuffs,and 2 patients(13.3%)received 5.0cm cuffs.The MUP and MUCP of AUS device in inactivated state were(82.5±30.2)cmH_(2)O and 51.0(48.0,77.0)cmH_(2)O.In the activated state,MUP was(138.9±21.7)cmH_(2)O and MUCP was 109.0(94.0,133.0)cmH_(2)O.Compared with that before operation,the urethral pressure in the inactivated state did not increase significantly(all P>0.05),while the urethral pressure in the activated state increased significantly(all P<0.001).The patients were followed-up for 3-33 months.Thirteen patients(86.7%)used the initial installation device,and all of them met the standard of social continence.One patient died of cerebrovascular accident.One patient took out the device due to urethral erosion.The incidence of complications was 26.7%(4/15),including painless hematuria in 2 cases,scrotum and penis infection in 1 case,and urethral erosion in 1 case.The MUP and MUCP of these patients were(100.0±40.7)cmH_(2)O and(80.8±39.7)cmH_(2)O respectively.In the intraoperative active state,the MUP was(151.5±15.3)cmH_(2)O and the MUCP was(123.0±17.2)cmH_(2)O.The MUP of the other 3 patients in the device activation state was significantly higher than the average value,and all of them were above 150 cm H_(2)O,except one patient who was infected due to cognitive problems and chronic urinary retention.In 11 patients without complications,the MUP and MUCP were(76.1±24.7)cmH_(2)O and(55.1±20.0)cmH_(2)O respectively.In the intraoperative active state,the MUP was(134.4±22.5)cmH_(2)O and the MUCP was(108.5±29.8)cmH_(2)O.Conclusions AUS implantation has a definite curative effect.Poor comprehension,and MUP higher than 150 cmH_(2)O in the activated state of the device may be risk factors for complications.