Proposal of a new way to evaluate the external sphincter function prior male sling surgey

ABSTRACT Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.

摘要
研究目的：提出一种可客观评估男性尿道吊带术前外括约肌功能的新方法。
材料与方法：对10例因前列腺术后并发压力性尿失禁（stress urinary incontinence, SUI）且接受尿道后经闭孔吊带术（retrourethral transobturator sling, RTS）治疗的连续入组患者（年龄范围54~79岁），通过尿道压力描记图（urethral profilometry profile, UPP）获取静息状态下括约肌压力（sphincter pressure at rest, SPAR）与收缩状态下括约肌压力（sphincter pressure under contraction, SPUC），以此评估术前括约肌功能。本研究的手术成功率主要终点为术后垫重试验结果，并将其与术前垫重试验、复位试验（repositioning test, RT）、SPAR及SPUC进行相关性分析。术后将患者分为控尿良好组（无需使用尿垫）与尿失禁组。
结果：控尿良好组与尿失禁组的平均SPUC分别为188±8.8（中位数185.1，范围181~201）与96.9±49.4（中位数109.9，范围35.6~163.6），组间差异具有统计学意义（P=0.008）。术后控尿良好组与尿失禁组的平均24小时垫重试验结果分别为151±84.2g（中位数140，范围80~245）与973±337.1g（中位数1940，范围550~1200），组间差异具有统计学意义（P=0.008）。除1例外，所有控尿良好患者的复位试验（RT）均为阳性；3例尿失禁患者的RT结果为阳性，提示假阳性。所有术后控尿良好患者的SPUC均高于180厘米水柱，且术前垫重试验结果均低于245g。
结论：SPUC或可作为优化括约肌功能评估的手段，同时也可成为RTS术前患者筛选的有效工具。