Ekamjit S Deol, Francis A Jefferson, Anthony E Fadel, Vidit Sharma, Daniel J Blezek, Daniel S Elliott, Boyd R Viers, Brian J Linder
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引用次数: 0
Abstract
Background: Sarcopenia, characterized by low muscle mass, and aberrant adiposity changes, including visceral fat accumulation, has been associated with impaired physiologic stress response and wound healing. Artificial urinary sphincter (AUS) placement is the preferred surgical treatment for men with severe post-prostatectomy incontinence. Given the higher rates of maladaptive body composition changes in this older, high comorbidity population, this study explores their impact on AUS outcomes.
Methods: A retrospective analysis was performed including men who underwent primary AUS placement at the Mayo Clinic from 1999 to 2023 for post-prostatectomy incontinence and had cross sectional imaging available within 12 months prior to AUS implant. Sarcopenia and body composition were assessed from the available computed tomography (CT) scan using an algorithm that measures the area of different tissues at the L3 abdominal cross-section. The study investigated the association between sarcopenia [defined as skeletal muscle index (SMI) <52.4 cm2/m2] and adiposity (defined by total visceral and subcutaneous fat area) with all-cause reoperation, including specific etiologies of device infection/erosion, urethral atrophy, and device malfunction, using Cox proportional hazards models.
Results: There were 111 patients who had available imaging within the study timeframe, 61 (55%) of whom were classified as sarcopenic. Follow-up did not differ significantly between the two groups [2.11 (0.53-4.78) vs. 2.52 (0.36-5.80) years, P=0.52]. Sarcopenic patients had a lower body mass index (BMI) (29.1 vs. 32.7 kg/m2; P<0.001). No significant difference in overall device survival was observed between sarcopenic and non-sarcopenic patients (P=0.94) on Cox survival analysis. Sarcopenic patients had higher device infection rates, accounting for 16.7% (3/18) of device failures in the sarcopenic cohort compared to none in the non-sarcopenic cohort.
Conclusions: Sarcopenia was prevalent among AUS patients but did not significantly impact overall device survival. These findings suggest that AUS placement may be feasible to perform in well-selected sarcopenic patients.
背景:肌肉疏松症的特点是肌肉质量低、脂肪异常变化(包括内脏脂肪堆积),与生理应激反应和伤口愈合受损有关。人工尿道括约肌(AUS)置入术是前列腺切除术后严重尿失禁男性的首选手术治疗方法。考虑到这一高龄、高合并症人群的身体成分不良变化率较高,本研究探讨了这些变化对人工尿道括约肌置入术结果的影响:本研究进行了一项回顾性分析,研究对象包括1999年至2023年期间因前列腺切除术后尿失禁而在梅奥诊所接受初级AUS置入术的男性,他们在AUS植入前12个月内接受了横断面影像学检查。根据现有的计算机断层扫描(CT)扫描结果,采用测量 L3 腹部横截面不同组织面积的算法,对肌肉疏松症和身体成分进行了评估。研究采用 Cox 比例危险模型,调查了肌肉疏松症(定义为骨骼肌指数 (SMI) 2/m2)和肥胖症(定义为内脏和皮下脂肪总面积)与全因再手术之间的关系,包括器械感染/侵蚀、尿道萎缩和器械故障等特定病因:共有 111 名患者在研究时间范围内进行了影像学检查,其中 61 人(55%)被归类为肌无力患者。两组患者的随访时间差异不大[2.11(0.53-4.78)年 vs. 2.52(0.36-5.80)年,P=0.52]。肌少症患者的体重指数(BMI)较低(29.1 vs. 32.7 kg/m2;PC结论:肌肉疏松症在 AUS 患者中很普遍,但对设备的总体存活率没有明显影响。这些研究结果表明,在精心挑选的肌肉疏松患者中进行 AUS 置入手术是可行的。
期刊介绍:
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.