Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4084-4090
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4084
Urethral pressure profilometry in artificial urinary sphincter implantation: A case report
Ling-Feng Meng, Xiao-Dong Liu, Miao Wang, Wei Zhang, Yao-Guang Zhang
Ling-Feng Meng, Xiao-Dong Liu, Miao Wang, Wei Zhang, Yao-Guang Zhang, Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Author contributions: Meng LF and Liu XD wrote the manuscript and were involved in the concept and submission of the manuscript; Wang M and Zhang W analyzed the patient’s clinical data; Zhang YG treated the patient and revised the manuscript; All authors approved the final version of this manuscript.
Supported by National Key R and D Program of China, No. 2018YFC2002202.
Informed consent statement: The patient involved in this study provided informed consent.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yao-Guang Zhang, MD, Doctor, Professor, Department of Urology, Beijing Hospital, National Center of Gerontology, No. 1, Dongdan Dahua Road, Dongcheng District, Beijing 100730, China. zhangyaoguang3247@bjhmoh.cn
Telephone: +86-13031099662
Received: July 29, 2019
Peer-review started: July 29, 2019
First decision: October 24, 2019
Revised: October 30, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: December 6, 2019
Processing time: 129 Days and 24 Hours
Abstract
BACKGROUND

Artificial urethral sphincter (AUS) implantation is currently the gold standard for treating moderate and severe urinary incontinence. Currently, cuffs are chosen based on the surgeon’s experience, and adjusting cuff tightness is crucial. The T-DOC air-charged catheter has not been proven to be inferior to traditional catheters. We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment, to guide cuff selection and adjustment.

CASE SUMMARY

A 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy, using five pads/d to maintain local dryness. Preoperatively, the maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) were 52 cmH2O and 17 cmH2O, respectively. An AUS was implanted. Intraoperatively, in the inactivated state, the MUP and MUCP were 53 cmH2O and 50 cmH2O, respectively; in the activated state, they were 112 cmH2O and 109 cmH2O, respectively. The pump was activated 6 wk postoperatively. Re-measurement of the urethral pressure on the same day showed that in the inactivated state, MUP and MUCP were 89 cmH2O and 51 cmH2O, respectively, and in the activated state, 120 cmH2O and 92 cmH2O, respectively. One month after device activation, telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d, which met the standard for social continence (0-1 pad per day). There were no complications.

CONCLUSION

The relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.

Keywords: Urethral pressure profilometry; Urinary sphincter, Artificial; Maximum urethral pressure; Maximum urethral closure pressure; Urinary incontinence; Case report

Core tip: At present, all medical centers choose cuffs based on the experience of the surgeon, without quantitative criteria. We report how the intraoperative urethral pressure profilometry can be performed by combining the T-DOC air-charged catheter and ambulatory urodynamic equipment to guide the selection and adjustment of cuffs. By comparing the effect of intraoperative urethral pressure on postoperative urinary continence, we can establish the relationship between the range of intraoperative urethral pressure and its effect on urinary continence to guide clinical diagnosis and treatment and to standardize artificial urethral sphincter implantation.