Participación del detrusor en la biomecánica de la replección vesical

El mecanismo por el que la presión intravesical se mantiene baja durante el llenado, no esta totalmente aclarado, aunque las propiedades mecánicas de la pared vesical, juegan un importante papel. Para estudiar la participación del detrusor en la fase de llenado vesical, y su influencia en las propiedades mecánicas vesicales, se realizo un estudio experimental de las presiones vesicales, mediante cistomanometria de llenado lento y rápido en 65 perros sometidos a la acción de diversos tipos de fármacos con acción sobre la dinámica vesical: atropina (agente anticolinergico), verapamil (inhibidor de los canales lentos del calcio), nitroprusiato (inhibidor del calcio intracelular) y egta (quelante del calcio). Partiendo de los modelos biomecanicos vesicales existentes, se elaboro un análisis matemático para investigar la influencia del elemento muscular activo sobre las propiedades mecánicas vesicales en la fase de llenado. También se estudio la participación de otros componentes de la pared vesical, como el colágeno, en la biomecánica vesical. La presión vesical de llenado disminuyo con el egta y el nitroprusiato. Hubo una tendencia a la disminución con el verapamil, mientras que no vario con la atropina. También se demostró una disminución con el egta de los parámetros viscoelasticos y musculares, mientras que los parámetros elástico y colágeno no variaron. De estos resultados se deduce la existencia de una actividad contráctil mantenida principalmente por el calcio intracelular, aunque precisa del calcio extracelular para el relleno de sus depósitos, no siendo dependiente de la estimulación colinergica. Dicha actividad influye sobre las propiedades viscoelasticas vesicales, siendo el componente muscular el responsable de dichas propiedades. Las propiedades elásticas no se afectan por la actividad contractil, siendo el colágeno el responsable. Por ultimo se propone un nuevo modelo biomecánico vesical formado por la alineación en serie de un cuerpo de maxwell con un elemento plasto-contractil, alineados a su vez en paralelo con un elemento de hooke

Participación del detrusor en la biomecánica de la replección vesical

Tesis Univ. Complutense de MadridEl mecanismo por el que la presión intravesical se mantiene baja durante el llenado, no esta totalmente aclarado, aunque las propiedades mecánicas de la pared vesical, juegan un importante papel. Para estudiar la participación del detrusor en la fase de llenado vesical, y su influencia en las propiedades mecánicas vesicales, se realizo un estudio experimental de las presiones vesicales, mediante cistomanometria de llenado lento y rápido en 65 perros sometidos a la acción de diversos tipos de fármacos con acción sobre la dinámica vesical: atropina (agente anticolinergico), verapamil (inhibidor de los canales lentos del calcio), nitroprusiato (inhibidor del calcio intracelular) y egta (quelante del calcio). Partiendo de los modelos biomecanicos vesicales existentes, se elaboro un análisis matemático para investigar la influencia del elemento muscular activo sobre las propiedades mecánicas vesicales en la fase de llenado. También se estudio la participación de otros componentes de la pared vesical, como el colágeno, en la biomecánica vesical. La presión vesical de llenado disminuyo con el egta y el nitroprusiato. Hubo una tendencia a la disminución con el verapamil, mientras que no vario con la atropina. También se demostró una disminución con el egta de los parámetros viscoelasticos y musculares, mientras que los parámetros elástico y colágeno no variaron. De estos resultados se deduce la existencia de una actividad contráctil mantenida principalmente por el calcio intracelular, aunque precisa del calcio extracelular para el relleno de sus depósitos, no siendo dependiente de la estimulación colinergica. Dicha actividad influye sobre las propiedades viscoelasticas vesicales, siendo el componente muscular el responsable de dichas propiedades. Las propiedades elásticas no se afectan por la actividad contractil, siendo el colágeno el responsable. Por ultimo se propone un nuevo modelo biomecánico vesical formado por la alineación en serie de un cuerpo de maxwell con un elemento plasto-contractil, alineados a su vez en paralelo con un elemento de hooke.Depto. de CirugíaFac. de MedicinaTRUEpu

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.Sin financiación2.6 Q3 JCR 20220.729 Q2 SJR 2023No data IDR 2022UE

Compression or obstruction: Prospective analysis of the function of the Adjustable Transobturator Male System (ATOMS) based on preand postoperative urodynamic data

Introduction: This analysis, based on pre- and postoperative urodynamic data, is the first to elucidate the influence of the Adjustable Transobturator Male System (ATOMS, A.M.I. GmbH, Feldkirch, Austria) on the lower urinary tract and disclose possible obstructive properties. Methods: A prospective study was performed in patients who had stress urinary incontinence and were scheduled for ATOMS implantation after radical prostatectomy. Apart from continence assessment (24-hour pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-SF]), urodynamic testing was done with International Continence Society (ICS)-standardized pressure-flow analysis before and after ATOMS implantation/adjustment. The Wilcoxon signed-rank test was used for statistical analysis. Results: The analysis included 12 consecutive patients from two centers (mean age 69 years) with a mean followup of 246 days. Median urine leakage dropped from 240 (72-1250) to 70 (0-700) g/24 hours postoperatively, with a pad reduction of 4 to 0.9 pads/ day. Pressure-flow analysis revealed a significant change only in the bladder outlet obstruction index (BOOI). The bladder contractility index, intravesical pressure conditions, and uroflowmetry were not significantly affected. None of the patients showed de novo obstruction postoperatively in the ICS analysis. Conclusions: The ATOMS significantly increases the BOOI in conjunction with good continence results. However, no case reached pathological level according to the BOOI and thus there is no potential danger to the lower urinary tract or urethral integrity.Sin financiación2.052 JCR (2021) Q4, 68/90 Urology & Nephrology0.440 SJR (2021) Q3, 56/108 UrologyNo data IDR 2021UE

Intraoperative Urethral Pressure Measurements in Patients with Adjustable Transobturator Male System (Atoms) Can Help to Understand the Mode of Action of this Incontinence Device

Male stress urinary incontinence (SUI) is a distressful complication of prostatic surgery either for prostate cancer or benign prostatic hyperplasia. Adjustable Transobturator male system (ATOMS) is increasingly used for the surgical treatment of male SUI. This system is based on ventral compression of the bulbar urethra by a filling a cushion. Compared to the artificial urinary sphincters the advantages of this system are its simplicity, the much lower risk of urethral atrophy or erosion, and the possibility of postoperative adjustment (1). However, its mode of action is not well understood. Our hypothesis is that the compression produced by the cushion filling produces a stretching effect on the bulbar urethra that increases urethral resistance and enhances the residual sphincteric activity, and also that different response to serial filling of the cushion intraoperatively after ATOMS placement could help to define the patients with best postoperative results. We performed intraoperative measurement in a consecutive series of patients intervened with ATOMS to evaluate the relationship between cushion filling volume and intraurethral bulbar pressure at the place of ATOMS contact.Sin financiación2.367 JCR (2021) Q3, 63/90 Urology & Nephrology1.288 SJR (2021) Q1, 73/378 Neurourology And UrodynamicsNo data IDR 2021UE

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.Depto. de CirugíaFac. de MedicinaTRUEpubDescuento UC

Do voiding urodynamic parameters predict the success of adjustable transobturator male system (ATOMS) to treat postprostatectomy urinary incontinence?

Objective: To evaluate whether urodynamic voiding risk factors can be predictive of failure of postprostatectomy urinary incontinence (PPI) treatment with adjustable transobturator male system (ATOMS). Materials and methods: We carried out a longitudinal study on 77 males treated for PPI with ATOMS. Patients were submitted preoperatively to a urodynamic study. The postoperative outcome was checked by pad-test. Treatment success was defined as daily pad-test below 10 mL. Statistical analysis used were Fisher exact test, χ2 lineal by lineal test, Student t test, and logistic regression analysis. The signification level was set at 95% bilateral. Results: Treatment was successful in 54 patients (70%) achieving continence. The urodynamic parameters that related to postoperative continence outcome were the cystometric bladder capacity (direct relationship with continence (P = .019), type of voiding (more probability to achieve continence in patients who voided voluntarily followed by patients with involuntary voiding and abdominal straining voiding) (P = .034), Bladder Outlet Obstruction Index (BOOI) (inversely related with continence) (P = .025), and maximum voiding abdominal pressure (inversely related with continence) (P = .049). Multivariate analysis showed that cystometric bladder capacity (odds ratio [OR], 1.01; confidence interval [CI], 1.02-1.00), BOOI (OR, 0.97; CI, 0.99-0.94), and maximum abdominal bladder pressure (OR, 0.97; CI, 0.98-0.94) were independent risk factors to predict treatment success after ATOMS implant. Conclusions: The study of functional voiding parameters is useful to know the risk factors that influence postoperative outcome of PPI with ATOMS device. These findings could be of primary importance to facilitate optimum patient selection for this implant and therefore improve operative results.Sin financiación2.696 JCR (2020) Q3, 50/89 Urology & Nephrology0.918 SJR (2020) Q1, 27/107 UrologyNo data IDR 2020UE

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture

(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (&ge;6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test &le; 20 mL/day, and complication rate, including device removal. The secondary variable was self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher&rsquo;s exact test and logistic regression were performed. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p &lt; 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1&ndash;3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p &lt; 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p &lt; 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p &lt; 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2&ndash;18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09&ndash;1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19&ndash;1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08&ndash;110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15&ndash;2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17&ndash;2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

Introduction: A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. Methods: Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated. Results: One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (- 470 vs. - 1000 ml; p < 0.0001) and so was ICIQ-SF (15.62 vs. 18.3; p < 0.001), but total dryness (76.5 vs. 66.7%; p = 0.33), social continence (90.2 vs. 85.2%; p = 0.49) and satisfaction (92.2 vs. 88.9%; p = 0.69) were equivalent. The postoperative complication rate was similar (22.6 vs. 29.6%; p = 0.4). The surgical revision rate was higher for AUS (6.9 vs. 22.2%; p = 0.029) and also the explant rate but did not reach statistical significance (4.9 vs. 14.8%; p = 0.09). Time to explant was shorter for AUS (log-rank p = 0.021). Regression analysis revealed radiation (p = 0.003) and incontinence severity (p = 0.029) predict total dryness, while complications (p < 0.005) and type of device (p = 0.039) independently predict surgical revision. Conclusions: Both ATOMS and AUS are effective devices. Pad test change for AUS exceeds that of ATOMS. The revision rate is higher for AUS, and durability is superior for ATOMS. The satisfaction rate is equivalent. Larger series and longer follow-up are needed to compare both devices more appropriately. According to our experience, the AUS is not the only gold standard for PPI.Sin financiación4.070 JCR (2021) Q2, 111/279 Pharmacology & Pharmacy1.0032 SJR (2021) Q1, 445/2489 Medicine (Miscellaneous)No data IDR 2021UE