University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.
Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK.
World J Urol. 2021 Apr;39(4):1227-1232. doi: 10.1007/s00345-020-03288-8. Epub 2020 Jun 6.
To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection.
We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre.
Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25).
Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.
研究男性吊带患者术前尿动力学参数，以确定其是否能更好地预测手术结果并有助于患者选择。
我们对 2012 年至 2019 年间在伦敦三家医院接受 AdVanceXP 男性吊带手术的男性进行了回顾性病例和视频尿动力学研究。所有中心均进行尿动力学检查，其中一个中心进行逆行漏点压（RLPP）检查。
需要每天使用 1 个或更少尿垫的 130 名男性中有 99 名（76%）获得成功。干率为 51%。垫使用与手术结果较差相关，成功率组的平均垫使用量为 2.6（范围 1-6.5），而非成功率组为 3.6（范围 1-10），尽管范围较宽（p=0.002）。24 小时垫重量也具有统计学意义（p=0.05），成功率组的平均重量为 181 克，而非成功率组为 475 克。非成功率组的 DO 发生率明显高于成功率组（55%对 29%，p=0.0009）。膀胱容量小于 250ml 也与较差的结果相关（p=0.003）。顺应性降低与结果无关（成功率组为 31%，非成功率组为 45%，p=0.15）。术前 RLPP 检查在 60/130 名患者中进行，但未独立达到统计学意义（p=0.25）。
与膀胱功能相关的尿动力学参数（逼尿肌过度活动和最大膀胱容量降低）可预测男性吊带手术结果，并可能有助于男性吊带（或括约肌）手术的患者选择；而括约肌功能不全（RLPP）的尿动力学参数无预测价值。需要进一步的大规模研究来证实这些发现。
