Department of Urology, Faculty of Medicine, Ain Shams University, Cairo.
Department of Pathology Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman.
Arch Ital Urol Androl. 2024 May 9;96(2):12395. doi: 10.4081/aiua.2024.12395.
To analyze the static and dynamic urodynamic parameters of reservoirs and continent conduits in continent cutaneous urinary diversion with catheterizable stoma.
76 patients had augmented ileocystoplasty or continent urinary diversion with catheterizable urinary stoma based on Mitrofanoff principle and Yang-Monti procedure using subserous tunnel as continence mechanism. They were followed up for at least 6 months post-operatively for continence through stoma and divided into two groups (continents vs non-continent) according to stomal continence. Both groups had urodynamic assessment performed via the stoma to assess reservoir capacity, pressure and contractions, efferent limb functional length, reservoir overactivity, static and dynamic maximal closure pressures and leak point pressure.
Continence rate was 87%. Continent group included 66 patients and incontinent group included 10 patients. In both groups at rest, the reservoir pressure after filling did not exceed 25 cm H2O. During peristaltic contraction, the pressure did not exceed 30 cm H2O and the duct remained continent. After Valsalva maneuver, the reservoir pressure increased up to 34 (+ 7.4) cm H2O and leakage occur in 10 patients (13%). Reservoir (wall) overactivity was recorded in 54 patients, with insignificant rise in intraluminal pressure during the contractions. In both groups, the efferent tract closing pressure was always higher than the reservoir pressure. The mean of maximal closing pressure at Valsalva was 82.5 (+ 4.18) cm H2O in the continent group and 61.66 (+ 8.16) cm H2O in the incontinent group. The mean functional length of the conduit was 4.95 + 1.62 in the continent group and 2.80 + 1.50 cm in the incontinent group.
Urodynamic evaluation of continent catheterizable cutaneous stoma after Yang-Monti procedure has a practical significance. Functional length of the conduit seems to be the most influential factor for continence reflecting static & dynamic maximal closure pressure. Higher conduit closing pressure is associated with better continence. Contractions of the pouch and peristaltic contraction of the conduit has no effect on continence mechanism.
分析经皮可控造口术行间置储尿囊和控尿通道的静态和动态尿动力学参数。
76 例患者接受了基于 Mitrofanoff 原理和 Yang-Monti 手术的增强回肠膀胱或可控性尿流改道术，通过浆膜下隧道作为控尿机制，建立可经导管排尿的造口。所有患者术后至少随访 6 个月以评估经造口排尿的控尿情况，根据造口控尿情况将患者分为两组（控尿组和非控尿组）。两组患者均通过造口进行尿动力学评估，以评估储尿囊容量、压力和收缩、输出道功能长度、储尿囊过度活动、静态和动态最大关闭压力以及漏尿点压力。
控尿率为 87%。控尿组 66 例，非控尿组 10 例。两组患者在静息状态下，充盈后储尿囊压力均未超过 25cmH2O。在蠕动收缩时，压力均未超过 30cmH2O，且导管保持控尿。行瓦氏动作后，储尿囊压力增加至 34（+7.4）cmH2O，10 例（13%）患者发生漏尿。记录到 54 例患者储尿囊（壁）过度活动，收缩时腔内压力无明显升高。两组患者输出道关闭压始终高于储尿囊压力。控尿组在瓦氏动作时最大关闭压力的平均值为 82.5（+4.18）cmH2O，非控尿组为 61.66（+8.16）cmH2O。控尿组输出道的平均功能长度为 4.95+1.62cm，非控尿组为 2.80+1.50cm。
Yang-Monti 手术后经皮可控造口术的尿动力学评估具有实际意义。输出道的功能长度似乎是影响控尿的最主要因素，反映了静态和动态最大关闭压力。更高的输出道关闭压与更好的控尿相关。储尿囊的收缩和输出道的蠕动收缩对控尿机制没有影响。
