Urinary Sphincter Disorders of Neurological Origin: Prognostic Aspects in the Neurology Department of the Ignace Deen National Hospital

Introduction: Complications of Urinary sphincter disorders of neurological origin can be life threatening. The objective of this study was to describe the prognosis of urinary sphincter disorders during neurological conditions. Methods: This was a six-month analytical study conducted at the neurological unit of the Hôpital national Ignace Deen. Including patients with urinary sphincter disorders following a neurological condition;Chi-square, Fischer, and Student’s t-tests were used for variables with a p value less than 0.10 and then included in a logistic model with a significance level set at 0.05 and a 95% confidence interval. Results: We collected 1081 patients among whom, 324 presented, that is to say a frequency of 30%, which concerned subjects aged 57.3 ± 16.4 years with a slight female predominance 50.3%. Urinary incontinence (80.6%) was associated with complications such as urinary tract infection with a high proportion of cerebral damage (92.3%). HIV infection (P = 0.015), bedsores (P = 0.049), and inhalation pneumonia (P = 0.001) were the main poor prognostic factors. Conclusion: Urinary sphincter disorders are elements of poor prognosis, both vital and functional, concerning elderly subjects with a predominance of urinary incontinence. HIV infection, bedsores, pneumopathy are poor prognostic factors.

Simultaneous penile prosthesis and male sling/artificia urinary sphincter

Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

Objective:The artificial urinary sphincter(AUS)is the gold standard for severe male stress urinary incontinence,though evaluations of specific predictors for device outcomes are sparse.We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures.Methods:We identified 2045 consecutive AUS surgeries at Mayo Clinic(Rochester,MN,USA)from 1983 to 2013.Of these,1079 were primary AUS implantations and 281 were initial revision surgeries,which comprised our study group.Device survival rates,including overall and specific rates for device infection/erosion,urethral atrophy and mechanical failure,were compared between primary AUS placements versus revision surgeries.Patient follow-up was obtained through office examination,written correspondence,or telephone correspondence.Results:During the study period,1079(79.3%)patients had a primary AUS placement and 281(20.7%)patients underwent a first revision surgery for mechanical failure or urethral atrophy.Patients undergoing revision surgery were found to have adverse 1-and 5-year AUS device survival on Kaplan-Meier analysis,90%vs.85% and 74%vs.61%,respectively(p<0.001).Specifically,revision surgery was associated with a significantly increased cumulative incidence of explantation for device infection/urethral erosion(4.2%vs.7.5%at 1 year;p=0.02),with similar rates of repeat surgery for mechanical failure(p=0.43)and urethral atrophy(p=0.77).Conclusions:Our findings suggest a significantly higher rate of overall device failure following revision AUS surgery,which is likely secondary to an increased rate of infection/urethral erosion events.

Urethral pressure profilometry in artificial urinary sphincter implantation: A case report

BACKGROUND Artificial urethral sphincter(AUS)implantation is currently the gold standard for treating moderate and severe urinary incontinence.Currently,cuffs are chosen based on the surgeon’s experience,and adjusting cuff tightness is crucial.The TDOC air-charged catheter has not been proven to be inferior to traditional catheters.We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment,to guide cuff selection and adjustment.CASE SUMMARY A 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy,using five pads/d to maintain local dryness.Preoperatively,the maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)were 52 cmH2O and 17 cmH2O,respectively.An AUS was implanted.Intraoperatively,in the inactivated state,the MUP and MUCP were 53 cmH2O and 50 cmH2O,respectively;in the activated state,they were 112 cmH2O and 109 cmH2O,respectively.The pump was activated 6 wk postoperatively.Re-measurement of the urethral pressure on the same day showed that in the inactivated state,MUP and MUCP were 89 cmH2O and 51 cmH2O,respectively,and in the activated state,120 cmH2O and 92 cmH2O,respectively.One month after device activation,telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d,which met the standard for social continence(0-1 pad per day).There were no complications.CONCLUSION The relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.

Beware of the Dog: Traumatic Extrusion of an Artificial Urinary Sphincter Following Blunt Trauma to the Scrotum by a Domestic Animal

Artificial urinary sphincters are commonly used in males with intrinsic sphincter deficiency to improve continence and quality of life. Complications include erosion, mechanical failure and infection. Frequently, a staged approach involving removal of the device, followed by a period of healing and subsequent reinsertion of a new sphincter is required to restore continence. We describe the first case ever reported of traumatic sphincter extrusion following blunt scrotal trauma by a dog and review its clinical features and management.

Artificial urinary sphincter:current status and future directions

Urge urinary incontinence(UUI)is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions.For many decades,there have been attempts to reduce the morbidity of this outcome with variable results.Since its development in the 1970s,the artificial urinary sphincter(AUS)has been the“gold standard”for treatment of the most severe cases of UUI.Other attempts including injectable bulking agents,previous sphincter designs,and slings have been developed,but largely abandoned because of poor long-term efficacy and significant complications.The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy.None of these changes in the basic AUS design have occurred in the past three decades,and the AUS remains the same despite newer technology and materials that could improve its function and safety.Recently,newer compressive devices and slings to reposition the bladder neck for men with mildto-moderate UUI have been developed with success in select patients.Similarly,the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon(PRB)to reduce infection risk.The basic AUS design,however,has not changed.With newer electronic technology,the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported.While the eAUS is as yet not available,its development continues and a prototype device may be available soon.Possible design options are discussed in this review.

Artificial urinary sphincter surgery in the special populations:neurological,revision,concurrent penile prosthesis and female stress urinary incontinence groups

The artificial urinary sphincter(AUS)remains the standard of care in men with severe stress urinary incontinence(SUI)following prostate surgery and radiation.While the current AUS provides an effective,safe,and durable treatment option,it is not without its limitations and complications,especially with regard to its utility in some“high-risk”populations.This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury,revision cases,concurrent penile prosthesis implant,and female SUI.The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations.Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.

Management of urethral atrophy after implantation of artificial urinary sphincter:what are the weaknesses?

The use of artificial urinary sphincter(AUS)for the treatment of stress urinary incontinence has become more prevalent,especially in the“prostate-specific antigen(PSA)-era”,when more patients are treated for localized prostate cancer.The first widely accepted device was the AMS 800,but since then,other devices have also entered the market.While efficacy has increased with improvements in technology and technique,and patient satisfaction is high,AUS implantation still has inherent risks and complications of any implant surgery,in addition to the unique challenges of urethral complications that may be associated with the cuff.Furthermore,the unique nature of the AUS,with a control pump,reservoir,balloon cuff,and connecting tubing,means that mechanical complications can also arise from these individual parts.This article aims to present and summarize the current literature on the management of complications of AUS,especially urethral atrophy.We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management.We review the various potential complications and their management.AUS complications are either mechanical or nonmechanical complications.Mechanical complications usually involve malfunction of the AUS.Nonmechanical complications include infection,urethral atrophy,cuff erosion,and stricture.Challenges exist especially in the management of urethral atrophy,with both tandem implants,transcorporal cuffs,and cuff downsizing all postulated as potential remedies.Although complications from AUS implants are not common,knowledge of the management of these issues are crucial to ensure care for patients with these implants.Further studies are needed to further evaluate these techniques.

电针气海、中极、关元穴改善压力性尿失禁尿道括约肌线粒体损伤机制研究

目的:观察电针对压力性尿失禁(SUI)环境下尿控的影响,并基于线粒体动力学探讨相关作用机制。方法:对SD大鼠进行随机分组,空白组未采取任何处理,假手术组完成手术解剖未干预,模型组行双侧卵巢切除+阴道扩张,假针组予非穴位电针,电针组进行穴位电针。尿动力学仪测量各组大鼠的最大膀胱容量(MBC)和腹腔漏尿点压力(ALPP)和漏尿点压力(LPP);HE染色观察尿道括约肌肌纤维形态改变;ELISA试剂盒检测线粒体膜电位、ATP和氧化应激相关指标;电镜观察尿道括约肌线粒体形态;Western blot检测尿道括约肌线粒体动力学相关因子线粒体融合素1(Mfn1)、Mfn2、线粒体动力相关蛋白1(Drp1)、线粒体分裂因子(MFF)、沉默信息调节因子1(SIRT1)和过氧化物酶体增殖物激活受体γ共激活因子-1α(PGC-1α)蛋白表达。结果:与假手术组比较,模型组大鼠尿控指标MBC、ALPP和LPP显著降低(均P<0.05),尿道括约肌纤维断裂、排列紊乱,线粒体明显肿胀,嵴增宽;线粒体膜电位、ATP、琥珀酸脱氢酶(SDH)和超氧化物歧化酶(SOD)水平显著降低(均P<0.05),丙二醛(MDA)水平显著升高(P<0.05);SIRT1、PGC-1α、Mfn1和Mfn2蛋白表达显著降低(均P<0.05),Drp1和MFF蛋白表达显著升高(均P<0.05)。与假针组比较,电针组大鼠的MBC、ALPP和LPP显著升高(均P<0.05),尿道括约肌纤维断裂、排列紊乱及线粒体的肿胀、嵴增宽情况显著改善;线粒体膜电位和ATP水平以及SDH和SOD活性显著升高(均P<0.05),MDA水平显著降低(P<0.05);SIRT1、PGC-1α、Mfn1、Mfn2蛋白表达显著升高(均P<0.05),Drp1和MFF蛋白表达显著降低(均P<0.05)。结论:电针可通过调控线粒体动力学改善SUI环境下尿道括约肌肌纤维形态和线粒体形态及功能障碍。

基于肛门括约肌临检的多系统萎缩病症分析

分析了多系统萎缩患者临床特点和肛门括约肌肌电图特征,探讨了肛门括约肌肌电图对多系统萎缩早期临床诊断的价值。回顾性分析多系统萎缩患者26例,采集患者一般资料、日常生活活动能力评分、肛门括约肌肌电图结果。以是否出现卫星电位、是否存在尿便障碍、是否有体位性低血压分别进行分组比较,比较组间患者的年龄、病程、日常生活活动能力评分、肛门括约肌肌电图结果。同时分析病程、肛门括约肌肌电图运动单位动作电位平均时限、日常生活活动能力评分和病程的相关性。26例多系统萎缩患者中最常见症状依次为尿便障碍、走路不稳及睡眠障碍;最常见体征依次为肌张力障碍、体位性低血压及共济失调;26例患者运动单位动作电位平均时限为11.6 ms(范围为10.1~14.5 ms),平均波幅为876.5μV(范围为740.8~1135.8μV),多相波百分比为27.4%(范围为13.3%~53.6%);卫星电位组比无卫星电位组运动单位动作电位平均时限长、多相波百分比高、日常生活活动能力评分低(P<0.05);体位性低血压组比无体位性低血压组日常生活活动能力评分低(P<0.05);多系统萎缩患者的病程与日常生活活动能力评分呈显著负相关(r=-0.695,P=0.000),病程与运动单位动作电位平均时限无明显相关性,日常生活活动能力评分与运动单位动作电位平均时限无明显相关性。多系统萎缩患者病程越长,病情越重,出现卫星电位或出现体位性低血压病情更重,肛门括约肌肌电图有利于无尿便障碍多系统萎缩患者早期诊断。

Combination therapy for male erectile dysfunction and urinary incontinence

Urinary incontinence （UI） and erectile dysfunction （ED） are both very prevalent conditions. Insertion of an artificial urinary sphincter （AUS） and penile prosthesis （PP） is an effective and proven method of treatment for both conditions. With advancing age, as well as with increasing populations of patients radically treated for prostate cancer, the occurrence of both conditions found in the same patient is increasing. The purpose of this article was to analyze the available evidence for simultaneous surgical management of male ED and UI using prosthetic devices. The existing literature pertaining to dual implantation of AUS and PP was reviewed. The concomitant insertion of the PP with the male perineal sling was also considered. Concurrent ED and UI are increasingly seen in the post radical prostatectomy population, who are often younger and less willing to suffer with these conditions. Insertion of an AUS and PP, either simultaneously or as a two-stage procedure, appears to be a safe, efficacious and long-lasting method of treatment. The improvements in design of both the AUS and PP as well as the development of the single transverse scrotal incision have made simultaneous insertion of these prostheses possible. Dual implantation of the PP and male sling looks promising in a selected population. In conclusion, the insertion of the AUS and PP for the treatment of concurrent UI and ED is safe and effective. Simultaneous insertion of these prostheses in the same patient offers potential advantages in operative and recovery time and is associated with high patient satisfaction. Combination therapy should therefore be included in the arsenal of treatment of these conditions.

A Review on Urinary Incontinence after Surgery for Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is characterized by the abnormal proliferation of cells, leading to structural changes. It is one of the most common diseases in ageing men. Its clinical presentations are dominated by lower urinary tract symptoms (LUTS). The therapeutic methods can be grouped into two options: the medical option and the surgical option in which prostate enucleation is found. In recent years many studies have reported the onset of urinary incontinence (UI) after prostate enucleation. The management of UI occurring after prostate enucleation is embarrassing for both the practitioner and the patient, and generates additional costs. Purpose: Cite the causes of UI after prostate enucleation for BPH, as well as ways to prevent the onset of UI after this surgery, specifically by the study of the vesicosphincteric system aimed at improving the technique of enucleation;our review will also deal with the therapeutic means of UI. Method: We retrieved studies from Science Direct, Wiley and Pubmed. Results: There are multiple etiologies of UI after prostate enucleation including urethral sphincter insufficiency (USI) and bladder dysfunction (BD). The management of UI after surgery could be conservative, surgical, or use new technologies. Urodynamic assessment before prostate enucleation for BPH is relevant. Conclusion: UI is a common post-operative complication of prostate enucleation. The study of the vesicosphincteric system leads us to believe that prostate enucleation for BPH, partially sparing the mucosa and the external urethral sphincter could decrease the incidence of UI after surgery.

A multidisciplinary approach to sphincter pharyngoplasty for correction of velopharyngeal dysfunction following repair of cleft palate

Background:Management of severe velopharyngeal dysfunction is best performed by a multispecialty team.This team could include a speech-language pathologist,otolaryngologist,prosthodontist,and a plastic surgeon.The most commonly performed surgical procedures in complicated cases with scarred soft palate are sphincter pharyngoplasty and pharyngeal flaps.In this study,a multidisciplinary approach was applied for proper assessment and surgical intervention using sphincter pharyngoplasty for velopharyngeal insufficiency after cleft palate repair.Methods:Twenty patients underwent sphincter pharyngoplasty.Preoperative diagnosis was performed using auditory perceptual assessment,nasoendoscopy assessment,nasometry,and videofluoroscopy.Results:There were statistically significant differences between the preoperative and postoperative assessments.Bleeding occurred in two patients.Obstructive sleep apnea occurred in three patients and was resolved spontaneously within three months,and one patient experienced slight wound dehiscence.Conclusion:Velopharyngeal dysfunction after cleft palate repair is best treated by a multidisciplinary team through speech therapy together with sphincter pharyngoplasty.

Regenerative medicine based applications to combat stress urinary incontinence

Stress urinary incontinence(SUI), as an isolated symptom, is not a life threatening condition. However, the fear of unexpected urine leakage contributes to a significant decline in quality of life parameters for afflicted patients. Compared to other forms of incontinence, SUI cannot be easily treated with pharmacotherapy since it is inherently an anatomic problem. Treatment options include the use of bio-injectable materials to enhance closing pressures, and the placement of slings to bolster fascial support to the urethra. However, histologic findings of degeneration in the incontinent urethral sphincter invite the use of tissues engineering strategies to regenerate structures that aid in promoting continence. In this review, we will assess the role of stem cells in restoring multiple anatomic and physiological aspects of the sphincter. In particular, mesenchymal stem cells and CD34+cells have shown great promise to differentiate into muscular and vascular components,respectively. Evidence supporting the use of cytokines and growth factors such as hypoxia-inducible factor1-alpha, vascular endothelial growth factor, basic fi-broblast growth factor, hepatocyte growth factor and insulin-like growth factor further enhance the viability and direction of differentiation. Bridging the benefits of stem cells and growth factors involves the use of synthetic scaffolds like poly(1,8-octanediol-co-citrate)(POC) thin films. POC scaffolds are synthetic, elastomeric polymers that serve as substrates for cell growth,and upon degradation, release growth factors to the microenvironment in a controlled, predictable fashion.The combination of cellular, cytokine and scaffold elements aims to address the pathologic deficits to urinary incontinence, with a goal to improve patient symptoms and overall quality of life.

Tanshinone ⅡA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction

Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.

Human primary muscle stem cells regenerate injured urethral sphincter in athymic rats

Background:The aim of the study was to demonstrate the efficacy of human muscle stem cells(MuSCs)isolated using innovative technology in restoring internal urinary sphincter function in a preclinical animal model.Methods:Colonies of pure human MuSCs were obtained from muscle biopsy speci-mens.Athymic rats were subjected to internal urethral sphincter damage by electro-cauterization.Five days after injury,2×105 muscle stem cells or medium as control were injected into the area of sphincter damage(n=5 in each group).Peak bladder pressure and rise in pressure were chosen as outcome measures.To repeatedly obtain the necessary pressure values,telemetry sensors had been implanted into the rat bladders 10 days prior to injury.Results:There was a highly significant improvement in the ability to build up peak pressure as well as a pressure rise in animals that had received muscle stem cells as compared to control(p=0.007)3 weeks after the cells had been injected.Only mini-mal histologic evidence of scarring was observed in treated rats.Conclusion:Primary human muscle stem cells obtained using innovative technology functionally restore internal urethral sphincter function after injury.Translation into use in clinical settings is foreseeable.

电针对骶上脊髓损伤大鼠急性期肾及下尿路功能的影响

目的 通过观察电针对急性期骶上脊髓损伤(suprasacral cord injury, SSCI)后逼尿肌-括约肌协同失调(detrusor sphincter dyscoordination, DSD)大鼠膀胱最大容量(maximum cystometric capacity, MCC)、漏尿点压力(leakage point pressure, LPP)、血清尿素氮(blood urea nitrogen, BUN)、血肌酐(serum creatinine, SCR)和肾组织形态学的改变,探讨电针治疗在SSCI急性期对上、下尿路功能(膀胱功能和肾功能)的影响。方法 36只SD雌性大鼠,随机抽取12只作为空白组,剩余24只采用改良Hassan Shaker脊髓横断法在T10脊髓节段全横断制作SSCI大鼠模型,成模后随机分为模型组和电针组,每组12只。电针组取“次髎”“中极”“三阴交”穴予持续电针刺激40 min,1次/d,连续治疗7 d;空白组与模型组只捆绑不治疗。采用膀胱造瘘法进行尿流动力学检测;随后腹主动脉采血,通过SCR、BUN检测评估肾功能;处死大鼠后取肾行HE染色,观察其组织形态结构的变化。结果 与空白组比,模型组大鼠MCC、LPP、BUN和SCR均显著升高(P<0.01);电针组大鼠MCC、BUN和SCR显著低于模型组(P<0.01),高于空白组(P<0.05或P<0.01);电针组大鼠LPP显著低于模型组(P<0.01),较空白组差异无统计学意义(P>0.05)。与模型组相比,电针组大鼠肾皮质炎性细胞浸润减轻、胞质空泡化减少,皮质部集合小管和肾小管上皮细胞核固缩减轻,肾小管坏死减少。结论 电针治疗可能通过降低SSCI后DSD大鼠MCC和LPP以改善肾脏微血管血流,发挥对肾功能和肾脏结构的保护作用。电针穴位可能刺激骶神经、胫神经的神经传入,促进尿道外括约肌爆发恢复,并且通过调节交感、副交感神经传出而影响排尿效率。

Qualitative analysis of online discussion boards for male urinary incontinence after prostate treatment

Introduction:Though urinary incontinence(UI)after prostate treatment often contributes to emotional distress and significantly impacts quality of life,many patients do not discuss this condition with their physicians.We analyzed the patient perspective by examining online support group posts to gain insight into specific challenges associated with different UI management methods. Methods:We examined discussion board threads from multiple patient-focused forums on experiences of UI due to prostate treatment(threads from January 2016 to January 2022).Principles of grounded theory in thematic analysis were used to analyze the threads. Results:Three hundred and eighteen posts from 84 unique users were analyzed.Among users,47(56%)reported UI following radical prostatectomy(RP),5(6%)secondary to radiation therapy(RT),12(14%)after a combination of RP and RT,and 20(24%)were ambiguous.UI management methods included pads/diapers/liners,condom catheters/external clamps,Kegels/pelvic floor physiotherapy,and surgical treatment(artificial urinary sphincter or sling placement).We identified challenges common to all management methods:"requires trial and error,""physical discomfort,"and"difficult to be in public."Factors influencing management choices included the ability to"feel normal"and the development of a management routine. Conclusion:The current study identifies opportunities for improved expectation-setting and education regarding post-procedural UI and its management.These findings can serve as a guide for providers to counsel patients on the advantages and disadvantages of UI management devices.

Delayed healing is common in in-situ urethroplasty patients after artificial sphincter cuff erosion

Introduction:Urethral erosion is a known complication of artificial urinary sphincter(AUS)surgery.We performed an in-situ urethroplasty(ISU)to reduce the healing time and time to reimplantation of the AUS.We sought to assess urethral integrity one month after ISU and to identify factors associated with delayed healing in our high-volume tertiary referral center experience. Methods:A retrospective review of our AUS database from 2009 to 2023 was conducted to identify all ISU cases.Patients were stratified as healed or non-healed based on the absence of extravasation on voiding cystourethrogram(VCUG)obtained 4 weeks postoperatively.Background characteristics were evaluated including age,body mass index,diabetes,hypogonadism and smoking history.Operative variables included degree of erosion,location of defect,and the number of stitches required for repair. Results:Among 98 patients undergoing an ISU,61 underwent VCUG at one month.Of these,34.4%(21/61)had evidence of delayed healing on VCUG requiring prolonged catheterization.Although a higher average number of repair sutures were used in ISU,this was not significant(p=0.381).The most common complication in both groups was urinary tract infection(UTI).Non-healed patients had a higher rate of UTI,without significant predilection towards fistula,stricture or diverticulum.No other patient or operative characteristic was significantly different between groups. Conclusion:Despite an aggressive approach to management via ISU,many patients still require prolonged catheterization after AUS erosion to ensure complete healing of the defect.

经直肠双平面超声检查对绝经后不同分度SUI女性尿道括约肌的评估

目的利用经直肠双平面高频超声及声触诊弹性成像(sound touch elastography,STE)技术,评估绝经后不同程度压力性尿失禁(stress urinary incontinence,SUI)女性尿道括约肌形态及弹性的变化。方法选取90例绝经后压力性尿失禁患者,根据Ingelman-Sundberg分度法进行分组,其中轻度组29例,中度组31例,重度组30例。选取同期正常的绝经后女性32例作为对照组。通过双平面探头观察尿道括约肌矢状切面和横切面的声像图特征,测量入组观察对象的尿道括约肌厚度、长度及采集各组尿道括约肌的平均弹性模量值(mean elastic modulus,Emean)。结果1)轻、中、重度组的尿道括约肌厚度、长度与对照组相比减小,Emean值增大,差异有统计学意义(P<0.05);2)重度组与轻度组、中度组相比,尿道括约肌长度、厚度均减小,Emean值增大,差异有统计学意义(P<0.05);3)轻度组尿道括约肌厚度、长度、Emean值与中度组相比,差异无统计学意义(P>0.05)。结论经直肠双平面高频超声及STE技术能定量评价尿道括约肌形态和弹性的变化,评估绝经后压力性尿失禁患者尿道括约肌受损的严重程度,为临床治疗及康复提供决策性依据。