Ruiz Sonia, Virseda-Chamorro Miguel, Salinas Jesús, Queissert Fabian, Arance Ignacio, Angulo Javier C
Departamento Clinico, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain.
Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
Neurourol Urodyn. 2022 Feb;41(2):609-615. doi: 10.1002/nau.24856. Epub 2021 Dec 30.
To assess changes in voiding phase, especially urethral resistance after post-prostatectomy urinary incontinence (PPI) treatment with the Adjustable TransObturator Male System (ATOMS).
A longitudinal prospective study was performed on 45 men treated with ATOMS for PPI, with the intention to evaluate the changes produced by the implant on the voiding phase. Patients with preoperative urodynamic study were offered postoperative urodynamic evaluation, and both studies were compared. The following urodynamic date were evaluated: maximum voiding detrusor pressure, detrusor pressure at maximum flow rate, maximum flow rate (Qmax), voiding volume, post-void residue, bladder outlet obstruction index (BOOI), urethral resistance factor (URA), and bladder contractility index (BCI). The statistical analysis used were the mean comparison test for dependent groups (Student's t test) for parametric variables and the Wilcoxon test for non-parametric variables. The signification level was set at 95% bilateral.
A total of 37 patients (82.2%) used zero pads/day at the time of urodynamic postoperative evaluation and pad-test evolved from 592 ± 289 ml baseline to 25 ± 40 ml (p = 0.0001). Significant differences were observed in Qmax (15 ± 8.3 before and 11 ± 8.3 after surgery; p = 0.008), voiding volume (282 ± 130.7 before and 184 ± 99.92 after surgery). BOOI (-12 ± 23.9 before and -2 ± 21.4 after surgery; p = 0.025) and BCI (93 ± 46.4 before and 76 ± 46.0 after surgery; p = 0.044). In no case did we observe postoperative bladder outlet obstruction, according to URA parameter below 29 cm H O in all cases. There was not a significant variation either in post-void urinary residual volume (15 ± 47.4 before and 14 ± 24.2 after surgery, p = 0.867).
The ATOMS implant induces a decrease of Qmax, voided volume, and bladder contractility and an increase of BOOI. However, our findings suggest that ATOMS device does not cause bladder outlet obstruction.
评估采用可调节经闭孔男性系统（ATOMS）治疗前列腺切除术后尿失禁（PPI）时排尿期的变化，尤其是尿道阻力的变化。
对45例接受ATOMS治疗PPI的男性患者进行了一项纵向前瞻性研究，旨在评估植入物对排尿期产生的变化。对术前进行尿动力学研究的患者进行术后尿动力学评估，并比较两项研究结果。评估了以下尿动力学数据：最大排尿逼尿肌压力、最大尿流率时的逼尿肌压力、最大尿流率（Qmax）、排尿量、残余尿量、膀胱出口梗阻指数（BOOI）、尿道阻力因子（URA）和膀胱收缩力指数（BCI）。所采用的统计分析方法为：对参数变量采用相关组均值比较检验（学生t检验），对非参数变量采用威尔科克森检验。显著性水平设定为双侧95%。
在术后尿动力学评估时，共有37例患者（82.2%）每天使用零片尿垫，尿垫试验量从基线时的592±289ml降至25±40ml（p = 0.0001）。在Qmax（术前15±8.3，术后11±8.3；p = 0.008）、排尿量（术前282±130.7，术后184±99.92）、BOOI（术前-12±23.9，术后-2±21.4；p = 0.025）和BCI（术前93±46.4，术后76±46.0；p = 0.044）方面观察到显著差异。根据URA参数，在所有病例中均未观察到术后膀胱出口梗阻，URA参数均低于29cmH₂O。术后残余尿量也没有显著变化（术前15±47.4，术后14±24.2，p = 0.867）。
ATOMS植入物可导致Qmax、排尿量和膀胱收缩力下降，以及BOOI升高。然而，我们的研究结果表明，ATOMS装置不会导致膀胱出口梗阻。
