Abstract：
BACKGROUND: A continent catheterizable channel (CCC) may be a solution for patients with impaired bladder emptying and difficult transurethral access. Leakage of the CCC is a common complication. To prevent leakage, the pressure in the CCC has to be higher than the reservoir (bladder/pouch) pressure in at least one location. It has not been clearly defined through which mechanism(s) the CCC achieves continence. In this feasibility study, we measured the CCC pressure profile in adult patients with various types of CCC\'s with and without stomal leakage.
METHODS: Adult patients with a CCC on a (augmented) bladder or pouch who underwent a urodynamic investigation between January and March 2023 were included. Next to the standard urodynamic investigation, a continuous stomal pressure measurement (CSP) and stomal pressure profilometry with empty bladder (SPP-1) and with filled bladder (SPP-2) of the CCC were performed.
RESULTS: A total of 17 patients were included. It was technically possible to perform SPP-1 and SPP-2 in all patients, and to measure the CSP in 16/17 patients. The median maximum stomal pressures in SPP-1 and SPP-2 were 112 (interquartile range [IQR], 76-140) cmH2O and 120 (IQR, 92-140) cmH2O, respectively. Nine patients had stomal leakage during the urodynamic investigation. In five patients, the detrusor leak point pressure (dLPP) was low (<20 cmH2O). A pressure peak at the beginning of SPP-2 was absent in all patients with stomal leakage at low dLPP.
CONCLUSIONS: SPP and CSP measurement in CCCs are feasible. We found differences in SPP-2 between patients with and without leakage at low dLPP, indicative of a role of the intravesical tunnel in continence or high dLPP. The results of this study may improve our understanding of the physiology and dynamics of CCCs as well as the management of CCC-related complications.
METHODS: Adult patients with a CCC on a (augmented) bladder or pouch who underwent a urodynamic investigation between January and March 2023 were included. Next to the standard urodynamic investigation, a continuous stomal pressure measurement (CSP) and stomal pressure profilometry with empty bladder (SPP-1) and with filled bladder (SPP-2) of the CCC were performed.
RESULTS: A total of 17 patients were included. It was technically possible to perform SPP-1 and SPP-2 in all patients, and to measure the CSP in 16/17 patients. The median maximum stomal pressures in SPP-1 and SPP-2 were 112 (interquartile range [IQR], 76-140) cmH2O and 120 (IQR, 92-140) cmH2O, respectively. Nine patients had stomal leakage during the urodynamic investigation. In five patients, the detrusor leak point pressure (dLPP) was low (<20 cmH2O). A pressure peak at the beginning of SPP-2 was absent in all patients with stomal leakage at low dLPP.
CONCLUSIONS: SPP and CSP measurement in CCCs are feasible. We found differences in SPP-2 between patients with and without leakage at low dLPP, indicative of a role of the intravesical tunnel in continence or high dLPP. The results of this study may improve our understanding of the physiology and dynamics of CCCs as well as the management of CCC-related complications.
摘要：
背景：大陆可导管通道（CCC）可能是膀胱排空受损且难以经尿道进入的患者的解决方案。CCC的泄漏是常见的并发症。为了防止泄漏，例如,CCC中的压力必须高于至少一个位置中的贮存器(囊/袋)压力。尚未明确定义CCC通过哪种机制实现节制。在这个可行性研究中,我们测量了有和没有造口渗漏的不同类型CCC成人患者的CCC压力曲线。
方法：纳入2023年1月至3月期间接受尿动力学检查的（扩大）膀胱或小袋患有CCC的成年患者。除了标准的尿动力学调查，对CCC的空膀胱(SPP-1)和充满膀胱(SPP-2)进行连续造口压测量(CSP)和造口压轮廓测量.
结果：共纳入17例患者。在技术上可以对所有患者进行SPP-1和SPP-2，并测量16/17患者的CSP。SPP-1和SPP-2的中位最大造口压力为112（四分位距[IQR]，76-140)cmH2O和120(IQR，92-140)cmH2O,分别。在尿动力学检查中，有9例患者发生了气孔渗漏。在五名患者中，逼尿肌漏点压力(dLPP)较低(<20cmH2O)。所有在低dLPP下有造口渗漏的患者在SPP-2开始时都没有压力峰值。
结论：在CC中进行SPP和CSP测量是可行的。我们发现，在低dLPP下，有和没有渗漏的患者之间SPP-2的差异，表明膀胱内隧道在失禁或高dLPP中的作用。这项研究的结果可能会提高我们对CC的生理学和动力学以及CCC相关并发症的管理的理解。
方法：纳入2023年1月至3月期间接受尿动力学检查的（扩大）膀胱或小袋患有CCC的成年患者。除了标准的尿动力学调查，对CCC的空膀胱(SPP-1)和充满膀胱(SPP-2)进行连续造口压测量(CSP)和造口压轮廓测量.
结果：共纳入17例患者。在技术上可以对所有患者进行SPP-1和SPP-2，并测量16/17患者的CSP。SPP-1和SPP-2的中位最大造口压力为112（四分位距[IQR]，76-140)cmH2O和120(IQR，92-140)cmH2O,分别。在尿动力学检查中，有9例患者发生了气孔渗漏。在五名患者中，逼尿肌漏点压力(dLPP)较低(<20cmH2O)。所有在低dLPP下有造口渗漏的患者在SPP-2开始时都没有压力峰值。
结论：在CC中进行SPP和CSP测量是可行的。我们发现，在低dLPP下，有和没有渗漏的患者之间SPP-2的差异，表明膀胱内隧道在失禁或高dLPP中的作用。这项研究的结果可能会提高我们对CC的生理学和动力学以及CCC相关并发症的管理的理解。
