摘要
目的探讨改良尿道分离方式在压力性尿失禁(SUI)患者人工尿道括约肌(AUS)植入术中的应用情况,及其对尿道压力描记检查结果的影响。方法前瞻性收集2019年3月至2023年6月在北京医院、首都医科大学附属北京积水潭医院和天津医科大学第二医院接受改良尿道分离方式AUS植入术并完成尿道压力描记检查的25例SUI患者的临床资料,改良尿道分离方式为在游离尿道海绵体背侧时,借用部分海绵体白膜组织。记录尿道周径、袖套尺寸及尿道压力情况,比较手术前后患者的自主控尿情况以及国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分、尿失禁生活质量问卷(I-QoL)评分、尿频评分及夜尿评分的变化情况。激活装置后的第1、3、6、12个月时于门诊或电话进行随访,之后每年进行1次随访。评估局部皮肤状态、控尿情况,测量残余尿量超声并完成主观评分量表测定。结果患者均为男性,年龄27~85岁(65.8±15.7)岁。选用4.0 cm袖套4例(16.0%),4.5 cm袖套16例(64.0%),5.0 cm袖套4例(16.0%),5.5 cm袖套1例(4.0%);其中尿道周径与袖套尺寸完全匹配14例(56.0%),尿道周径小于袖套尺寸4例(16.0%),尿道周径大于袖套尺寸7例(28.0%)。25例患者术前最大尿道压力(MUP)为(78.0±25.9)cmH_(2)O(1 cmH_(2)O=0.098 kPa),最大尿道闭合压力(MUCP)为(53.4±26.6)cmH_(2)O。采用AUS装置在术中失活状态下MUP为(88.0±26.5)cmH_(2)O,与术前差异无统计学意义(P>0.05);MUCP为(68.2±24.5)cmH_(2)O,高于术前(P<0.05)。术中激活状态下,MUP为(146.6±25.2)cmH_(2)O,MUCP为(123.0±28.3)cmH_(2)O,均高于术前及失活状态下(均P<0.001)。全组患者在装置激活的第1个月时,均达到社交控尿标准。全组患者随访2~50个月,随访过程中,22例(88.0%)患者达到社交控尿标准,1例患者更换AUS装置,1例患者因脑血管意外死亡,1例患者因并发症取出装置。25例患者术前和术后分别使用尿垫[M(Q_(1),Q_(3))]4.5(3.0,6.5)个和1(0,1)个,差异有统计学意义(P<0.001)。25例患者术后的ICI-Q-SF评分、I-QoL评分、尿频评分和夜尿评分均较术前明显改善(均P<0.05)。5例(20.0%)患者出现术后并发症,其中无痛性血尿2例,感染1例,尿道侵蚀1例,排尿困难1例。除出现尿道侵蚀的1例患者移除袖套外,其余4例患者在积极支持治疗下均恢复社交控尿,且至末次随访症状均未复发。结论改良尿道分离方式未明显影响SUI患者尿道压力,且可增加袖套内尿道周围组织体积,从而降低术中尿道损伤风险及术后尿道侵蚀的发生率。
Objective To explore the application of modified urethral separation method in artificial urethral sphincter(AUS)implantation in patients with stress urinary incontinence(SUI),and its influence on the results of urethral pressure profilometry.Methods A prospective collection of clinical data was conducted on 25 patients with stress urinary incontinence who underwent modified urethral separation method in AUS implantation and underwent urethral pressure profilometry in Beijing Hospital,Beijing Jishuitan Hospital Affiliated to Capital Medical University and the Second Hospital Affiliated to Tianjin Medical University from March 2019 to June 2023.The improved urethral separation method was to borrow part of the white membrane tissue of the cavernous body while freeing the dorsal side of the cavernous body of the urethra.The circumference of the urethra,sleeve size,and urethral pressure were recorded,the patient's autonomous urinary control before and after surgery and the changes of the international consultation on incontinence questionnaire-short form(ICI-Q-SF)score,incontinence quality of life questionnaire(I-QoL)score,urinary frequency score,nocturia score were compared.Follow-up was conducted in the clinic or by telephone at 1,3,6,and 12 months after activation of the device,and once a year thereafter.Local skin status and urine control were assessed,residual urine volume was measured by ultrasound and subjective score scale was completed.Results All patients were male,aged 27-85(65.8±15.7)years old.The circumference of the cuff used in this study was 4.0 cm in 4 patients(16.0%),4.5 cm in 16 patients(64.0%),5.0 cm in 4 patients(16.0%),and 5.5 cm in 1 patient(4.0%).Among them,the urethral circumference matched the cuff size in 14 cases(56.0%),the urethral circumference was smaller than the cuff size in 4 cases(16.0%),and the urethral circumference was larger than the cuff size in 7 cases(28.0%).Preoperative urodynamic examination showed that the maximum urethral pressure(MUP)was(78.0±25.9)cmH_(2)O,(1 cmH_(2)O=0.098 kPa)and the maximum urethral closure pressure(MUCP)was(53.4±26.6)cmH_(2)O.The MUP of AUS device in the inactivated state was(88.0±26.5)cmH_(2)O,which was not significantly higher than that before operation(P>0.05).The MUCP was(68.2±24.5)cmH_(2)O,which was significantly higher than that before operation(P<0.05).The MUP and MUCP of the AUS device in the activated state were(146.6±25.2)cmH_(2)O and(123.0±28.3)cmH_(2)O,which were significantly higher than those before surgery and in the inactivated state(both P<0.001).All patients in the group reached the social urinary control standards at the first month of device activation.During a follow-up period of 2-50 months,22 patients(88.0%)used the initial AUS device and all met social urinary control standards.The AUS device was replaced in 1 case.One patient died of cerebrovascular accident.One patient removed the device due to complications.The number of pads[M(Q_(1),Q_(3))]used in 25 patients before and after operation was 4.5(3.0,6.5)and 1(0,1)respectively,with statistically significant differences(P<0.001).ICI-Q-SF score,I-QoL score,urinary frequency score and nocturia score of 25 patients were significantly improved after surgery(all P<0.05).The incidence of postoperative complications was 20.0%(5/25),including 2 cases of painless hematuria,1 case of infection,1 case of urethral erosion,and 1 case of dysuria.Except for one patient who experienced urethral erosion and had his sleeve removed,the remaining four patients regained social urination control with active support treatment,and no symptoms recurred until the last follow-up.Conclusion The modified urethral separation method has no significant effect on urethral pressure in patients with SUI,and can increase the volume of peri-urethral tissue in the cuff,thereby reducing the risk of intraoperative urethral injury and the incidence of postoperative urethral erosion.
作者
孟令峰
敬吉波
王淼
刘晓东
侯惠民
周云鹤
张莹
王娟
王晶
王璐
吕盈盈
伍建业
张耀光
王晓明
王建伟
Meng Lingfeng;Jing Jibo;Wang Miao;Liu Xiaodong;Hou Huimin;Zhou Yunhe;Zhang Ying;Wang Juan;Wang Jing;Wang Lu;Lyu Yingying;Wu Jianye;Zhang Yaoguang;Wang Xiaoming;Wang Jianwei(Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Urology,South China Hospital Affiliated to Shenzhen University,Shenzhen 518111,China;Department of Urology,Beijing Jishuitan Hospital Affiliated to Capital Medical University,Beijing 100096,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第6期427-432,共6页
National Medical Journal of China
基金
中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2023-JKCS-21)
关键词
尿失禁
压力性
改良尿道分离方式
人工尿道括约肌
尿动力学
尿道压力描记
Urinary incontinence,stress
Modified urethral separation method
Artificial urinary sphincter
Urodynamics
Urethral pressure profilometry
作者简介
王晓明,原工作单位为天津医科大学第二附属医院泌尿外科,天津300010;通信作者:张耀光,Email:zhang003887@sina.com
