ABSTRACT
Objective:To explore the potential relationship of urethral pressure profilometry and the complications of artificial urethral sphincter (AUS) implantation.Methods:The clinical data of patients who underwent AUS implantation in Beijing Hospital from March 2019 to March 2022 were retrospectively analyzed. All the patients were male. The average course of disease was 43.1 months(ranging 11-120 months). The average age was (68.6±13.2) years. The median number of pads used was 4.5 (3.0, 6.0). The preoperative maximum urethral pressure (MUP) was (84.6±25.5) cmH 2O, and the maximum urethral closure pressure (MUCP) was 51.0 (41.0, 74.0) cmH 2O. AUS implantation was performed through a single perineal incision in all patients. The sleeve size was mainly determined by the measured urethral circumference of the patient. After installation of all components, the urethral pressure profilometry was performed under the state of device inactivation and activation. The pump was activated 6 weeks after the operation, and telephone follow-up was performed 3 months after the activation of the device. The urinary control and complications were recorded. The results of follow-up were compared with the results of urethral pressure profilometry, and the preliminary conclusions were drawn. Results:In this study, 3 patients (20%) received 4.0cm cuffs, 10 patients (66.7%) received 4.5cm cuffs, and 2 patients (13.3%) received 5.0cm cuffs. The MUP and MUCP of AUS device in inactivated state were (82.5±30.2) cmH 2O and 51.0(48.0, 77.0) cmH 2O. In the activated state, MUP was (138.9±21.7) cmH 2O and MUCP was 109.0(94.0, 133.0) cmH 2O. Compared with that before operation, the urethral pressure in the inactivated state did not increase significantly (all P > 0.05), while the urethral pressure in the activated state increased significantly (all P < 0.001). The patients were followed-up for 3-33 months. Thirteen patients (86.7%) used the initial installation device, and all of them met the standard of social continence. One patient died of cerebrovascular accident. One patient took out the device due to urethral erosion. The incidence of complications was 26.7% (4/15), including painless hematuria in 2 cases, scrotum and penis infection in 1 case, and urethral erosion in 1 case. The MUP and MUCP of these patients were (100.0 ± 40.7) cmH 2O and (80.8 ± 39.7) cmH 2O respectively. In the intraoperative active state, the MUP was (151.5 ± 15.3) cmH 2O and the MUCP was (123.0 ± 17.2) cmH 2O. The MUP of the other 3 patients in the device activation state was significantly higher than the average value, and all of them were above 150 cm H 2O, except one patient who was infected due to cognitive problems and chronic urinary retention. In 11 patients without complications, the MUP and MUCP were (76.1±24.7) cmH 2O and (55.1±20.0) cmH 2O respectively. In the intraoperative active state, the MUP was (134.4±22.5) cmH 2O and the MUCP was (108.5±29.8) cmH 2O. Conclusions:AUS implantation has a definite curative effect. Poor comprehension, and MUP higher than 150 cmH 2O in the activated state of the device may be risk factors for complications.
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Objective:To explore the efficacy and safety of robot assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.Methods:The data of 16 patients who underwent robot assisted laparoscopic sacrocolpopexy in Beijing Hospital from September 2019 to May 2022 were collected. The average age was (73.5±9.3) years, the preoperative course was 4-240 months, the body mass index was (24.2±1.7) kg/m 2, the number of births was (1.7±0.8), and the quantitative index of pelvic organ prolapse (POP-Q) was grade Ⅲ -Ⅳ. The maximum urine flow rate before operation was (9.6±3.4) ml/s, the maximum detrusor pressure during urination was 26 (20, 32) cmH 2O, the first sense urine volume of the bladder was (119.1±39.4) ml, the first sense urine urgency volume of the bladder was (253.6±75.7) ml, the maximum bladder pressure capacity was (406.0±79.8) ml, and the residual urine volume was 10 (10, 28) ml. The preoperative PFDI-20 score was 100 (70, 122) and the PFIQ-7 score was 107 (90, 160). During the robot assisted laparoscopic sacrocolpopexy, the right area of the sacral promontory was exposed, the anterior and posterior walls of the uterus were separated, and the 2 cm small hole was separated from the right broad ligament of the uterus. The mesh was cut into a "Y" shape and passed through the small hole. The anterior and posterior leaves of the Y-shaped mesh were sutured to fix the cervix, and the other end was fixed to the anterior longitudinal ligament of the sacrum. The operation time and intraoperative bleeding were observed. The effect of surgery was evaluated by preoperative and postoperative urodynamic imaging, POP-Q stage, PFDI-20 score and PFIQ -7 score. Results:All the 16 operations were successfully completed. No injury of urethra, bladder, rectum, important blood vessels and nerves occurred during the operation. The average operation time was (255.6±56.0) min, and the average amount of bleeding was (28.8±18.2) ml. There was no inhibitory contraction wave in 7 patients (44%) before operation, suggesting that there was detrusor overactivity. After operation, the detrusor overactivity disappeared or significantly decreased in 7 patients. The postoperative follow-up period was 3-36 months. During the follow-up period, one patient had recurrence, and the rest had no prolapse and urination problems. The POP-Q stage was reduced to grade 0-Ⅰ after the operation. The subjective satisfaction rate of patients was 94%. The PFDI-20 score [13(8, 24)] and PFIQ -7 score [11(6, 15)] after operation were significantly reduced ( P<0.001), the initial urgent volume of bladder (272.5±88.5) ml was significantly increased compared with that before operation ( P=0.038), and the maximum volume of bladder (427.2±79.2) ml was significantly increased compared with that before operation ( P=0.006). Image urodynamics showed that the patient basically recovered the pelvic floor anatomy and achieved functional reduction. Conclusions:Robot assisted laparoscopic sacrocolpopexy has good subjective and objective effects in POP, low recurrence rate and less complications. It needs a larger sample size study for confirming the improvement of bladder function.
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Objective:To evaluate the efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse(POP), and its impact on lower urinary tract function.Methods:This study retrospectively analyzed the clinical data of POP patients who had undergone robotic arm assisted laparoscopic hysterosacral fixation at our center from June 2019 to October 2020, and conducted exploratory research.Results:A total of 6 patients were included in the study, with POP quantitative staging above stage Ⅲ.The ages ranged from 70 to 82 years.The number of births each patient had given ranged from 1 to 3, & all were via vaginal deliveries.There were no significant changes in urodynamic parameter scores in any patients before and after surgery, but half of the patients had detrusor overactivity before surgery, which all disappeared after surgery.In addition, synchronous X-ray images showed that the postoperative pelvic organs were closer to the normal anatomical position.At the same time, quantitative staging of POP had achieved clear improvement, and related scale scores also significantly improved.One patient complained of occasional lumbar and back discomfort with postoperative over-stretching during outpatient review, which improved after symptomatic treatment.Conclusions:robotic arm assisted Laparoscopic hysterosacral fixation is satisfactory in efficacy and safety for POP patients, with good postoperative restoration of the uterus to the anatomical position and has insignificant influence on the function of the lower urinary tract.It is worth further assessment for wide application.
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BACKGROUND: As a method to effectively improve organic tolerance and velocity, altitude training has been gradually accepted by the coaches,and it is a problem to be solved to find the optimal altitude.OBJECTIVE: To establish rat models of stimulating altitude training, and observe the changes of myocardial cell structure in the altitude training, so as to provide scientific animal models for the physiological studies of altitude training, and provide more scientific theoretical evidence for the altitude training of athletes.DESIGN: Based on the division of altitude region in aerospace medicine,the experimental animals were divided into different altitude training groups and control groups. Morphological characters of cellular and subcellular structures were observed under electron microscope, the biochemical analysis of cardiac troponin T were performed, and then the myocardial injury was completely analyzed from two pathways of morphology and biochemistry.SETTING: Laboratory of Sports and Human Sciences, Tsinghua University.MATERIALS: The experiments were carried out in the Laboratory of Sports and Human Sciences, Tsinghua University from January 2000 to December 2002. Totally 372 male SD rats were used. The experimental materials included hypobaric oxygen chamber, Japanese H-500 transmission electron microscope and the kit for testing serum cardiac troponin T index.METHODS: After adaptive swimming training for 1 week, all the 372 rats were randomly divided into 9 groups and 54 subgroups, only 6 groups of them were analyzed in this experiment, including stimulating acute altitude hypoxia training at 4 000 m group (n=32), hypoxia without training group (n=24), stimulating acute altitude training at 4 000 m followed by reoxygen training for 1 week group (n=32), stimulating acute altitude training at 4000 m followed by reoxygen training for 2 weeks group (n=32), increasing altitude training group (n=32) and plain training control group (n=24). Rats in the plain training control group lived and trained in normal conditions,and those in the other groups all trained with swimming in the stimulating altitude environment for 4 weeks. They were trained for 7 days every week,once a day and 60 minutes for each time for 4 weeks. The serum cardic troponin T index of rats was detected and observed with enzyme-linked immunoabsorbent assay (ELISA). After stimulating acute altitude training at 4 000 m for 4 weeks followed by reoxygen training for 2 weeks, the rats were killed, and a small piece of myocardial tissue was taken from left and right ventricles, then double-stained with uranyl acetate and lead citrate,and the ultrastructure of the sections was observed with Japanese H-500 transmission electron microscope.MAIN OUTCOME MEASURES: The serum cardiac troponin T index of rats trained at different altitude, and the results of spectrum and observation of myocardial ultrastucture under electron microscope were mainly observed.RESULTS: ① Changes of body mass: The myocardial increasing rate in the hypoxia training group was significantly different from those in the hypoxia without training control group and plain training control group (P ＜ 0.01), and there was also significant difference between the latter two groups (P ＜ 0.05). The increasing rate of body mass was significantly different among the hypoxia training group, hypoxia without training control group and plain training control group (22.41％, 28.14％, 33.48％,P ＜ 0.01-0.05). ② Results of cardiac troponin T: Compared with the hypoxia without training group, the value of cardiac troponin T in the hypoxia training groups was significantly different, and significantly increased with weeks of training (P ＜ 0.01). During the hypoxia altitude training below 4 000 m for 1-4 weeks, the value of cardiac troponin T ranged in creased from 0.09 to 0.128 μg/L, and it gradually recovered to 0.09 μg/L after reoxygen training in plain for 2 weeks. ③ The results of observation under electron microscope showed that after acute hypoxia training at 4 000 m for 4 weeks, myocardial mitochondrial structure occurred mild swelling with the prolongation of training, and for the rats received reoxygen training in plain for 2 weeks, the thick and thin myofilaments of myocardial fibers formed light and dark bands were clear and distinct, and the myotomes arranged orderly, besides clustered or scattered glycogen granules, a great amount of mitochondria also existed among muscular bundles, no swelling, degeneration of vacuoles, lysis necrosis, interstitial edema and other pathological changes were observed.CONCLUSION: It is safe to train rats at any altitude below 4 000 m. The acute exercise training of great intensity directly at 4 000 m will cause the mild injury of cardiac subcellular structure, and the increase of cardiac troponin T concentration. The training by means of increasing altitude has slighter influence on the myocardial injury, and the recovery after training is also faster.