- 作者列表："Meng LF","Wang M","Zhang W","Liu XD","Zhang YG
RATIONALE:Stress urinary incontinence (SUI) refers to the involuntary leakage of urine when abdominal pressure increases. Midurethral slings (MUS) have become the main surgical method for treating SUI, but no quantitative standard for the degree of sling tightness during operation exists. We achieved this quantitative measurement using ambulatory urodynamic equipment. PATIENT CONCERNS:A 49-year-old woman presented to our hospital with intermittent urine leakage. Five pads were used daily to keep the vulva dry. The preoperative urethral pressure profilometry (UPP) showed that maximum urethral pressure (MUP) was 54 cmH2O and maximum urethral closure pressure (MUCP) was 53 cmH2O. DIAGNOSIS:According to the medical history and examination findings, the patient was diagnosed as SUI. INTERVENTIONS:The MUS and UPP were performed. OUTCOMES:The intraoperative UPP showed that MUP was 29 cmH2O and MUCP was 17 cmH2O. Three months after the operation, the patient was followed up by telephone. The amount of urine pad usage decreased from 5 pads/d to 0 pads/d, reaching the social control standard (0-1 pads/d). The patient's international consultation on incontinence questionnaire short form score decreased from 18 to 5, and their incontinence quality of life score increased from 12.5 to 78.4. The effect of urine control was satisfactory, and no complications occurred.Five months after operation, the patient was reexamined in the outpatient department. The UPP showed that the MUP was 98 cmH2O and the MUCP was 72 cmH2O. The patient still uses 1 pad/day. The international consultation on incontinence questionnaire short form score is 6 and incontinence quality of life score is 79.5. The curative effect is stable. LESSONS:MUS has become an effective surgical method for SUI, and the tightness of the sling directly affects the surgical outcome. We have achieved the measurement of urethral pressure during MUS. However, although we found that there is no obvious clinical significance of urethral pressure measurement in MUS operation, future research will benefit from our findings by improving upon our study design to help standardize the clinical diagnosis and treatment of MUS.
原理: 压力性尿失禁 (SUI) 是指当腹压增加时尿液的不自主渗漏。尿道悬吊术 (MUS) 已成为治疗SUI的主要手术方法，但对术中悬吊松紧程度尚无定量标准。我们使用动态尿动力学设备实现了这种定量测量。 患者关注: 一名49岁女性患者因间歇性漏尿就诊于我院。每天使用5个护垫保持外阴干燥。术前尿道压力轮廓术 (UPP) 显示最大尿道压 (MUP) 为54 cmH2O，最大尿道闭合压 (MUCP) 为53 cmH2O。 诊断: 根据病史及检查结果，诊断为SUI。 干预: 进行MUS和UPP。 结果: 术中UPP显示MUP为29 cmcmh2o，MUCP为17 cmH2O。术后3个月电话随访。尿垫使用量由5 pads/d降至0 pads/d，达到社会控制标准 (0-1 pads/d)。患者失禁问卷简表评分国际咨询从18下降到5，他们的失禁生活质量评分从12.5上升到78.4。对控尿令人满意，无严重并发症，.五个月，患者复查门诊.UPP显示MUP为98cmh2o，MUCP为72cmh2o。患者仍使用1 pad pad/天。失禁问卷简表评分国际咨询为6分，失禁生活质量评分为79.5分。疗效稳定。 教训: MUS已成为治疗SUI的有效手术方法，而吊带的松紧度直接影响手术结果。我们实现了MUS期间尿道压力的测量。然而，尽管我们发现尿道压力测量在MUS手术中没有明显的临床意义，但未来的研究将受益于我们的发现，通过改进我们的研究设计来帮助规范MUS的临床诊断和治疗。
METHODS::Kidney transplant recipients (KTRs) are susceptible to low levels of vitamin D, which may be responsible for mineral and bone metabolism disorders and play some role in the occurrence of cardiovascular, metabolic, immunologic, neoplastic, and infectious complications after kidney transplant. Kidney Disease Improving Global Outcomes (KDIGO) guidelines of the year 2017 recommended vitamin D supplementation in the first 12 months after transplant using the same treatment strategies for the general population. However, no recommendations are provided after the first 12 months due to a lack of sufficient data. This review analyses some studies that assessed the vitamin D status of KTRs and the effects of nutritional and active vitamin D supplementation on bone mineral density, cardiovascular disease, proteinuria, and graft function in KTRs.
METHODS:PURPOSE:We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy. MATERIALS AND METHODS:Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome. RESULTS:After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001). CONCLUSIONS:Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.
METHODS:PURPOSE:Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. MATERIALS AND METHODS:A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. RESULTS:At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. CONCLUSIONS:The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.