Batista Miranda J E, Arañó Bertrán P, Errando Smet C
Unidad de Urodinamia, Fundación Puigvert, Barcelona, España.
Arch Esp Urol. 2000 Jun;53(5):409-16.
To present the results achieved with the artificial urinary sphincter in the treatment of 44 patients with severe urinary incontinence.
From April 1990 to December 1998, an artificial urinary sphincter was implanted in 44 patients with severe urinary incontinence, aged 21 to 82 years (mean 56). These patients were categorized into the following groups: Group A comprised 24 males, aged 37 to 82 years (mean 66), who had undergone previous prostatic procedures. Four of them had undergone radical retropubic prostatectomy. The remaining 20 had undergone a total of 34 de-obstructive procedures (mean 1.7 procedures/patient; range 1-3); 28 were endoscopic procedures and 6 open prostatectomy. One of them had a previous ileocystoplasty due to severely low compliance. Ten were completely incontinent and were using a condom catheter (7), penile clamp (2) or permanent indwelling Foley catheter (1). The rest used a mean of 3.7 pads per day. Group B comprised 11 males with a complex urologic history: 9 had neurogenic dysfunction, 1 had bladder exstrophy and 1 had a previous cystectomy and Studer neobladder. Eight were using a condom catheter. The cuff was placed in the bulbar urethra in 8 (4-4.5 cm) and in the bladder neck in 4 (9-10 cm). Group C comprised 9 women with type III stress incontinence after failed previous interventions (range 1-4, mean 2.7). All of these patients required at least 3 pads per day (mean 4.5). The cuff was placed in the bladder neck with diameters ranging from 5 to 10 cm.
The mean follow-up was 28.5 months (range 8-96). One patient died two years after implantation of the artificial sphincter which was never activated. In group A, 83% are socially continent and 17 do not require pads. Three of the 20 patients with the artificial sphincter have undergone a total of 4 surgical revisions. In group B, the social continence rate was 63% with a 36% revision rate. Four patients required a complete change of the system. In group C, The continence rate with revision was 66%. One patient underwent two successive successful revisions and 3 required removal of the device, accounting for a failure rate of 33%. Definitive removal of the artificial sphincter was required in 3 females and 5 males. Aside from one male who refused a new implant, the rest were considered unsuitable for a new device. Six patients underwent at least one reoperation to change one or more parts of the system. Continence was recovered in 66% after the revision.
The artificial urinary sphincter achieves a good continence rate in patients with severe incontinence, although careful patient follow-up is required.
介绍人工尿道括约肌治疗44例重度尿失禁患者所取得的结果。
1990年4月至1998年12月，对44例年龄在21至82岁（平均56岁）的重度尿失禁患者植入人工尿道括约肌。这些患者被分为以下几组：A组包括24名男性，年龄在37至82岁（平均66岁），曾接受过前列腺相关手术。其中4例接受了根治性耻骨后前列腺切除术。其余20例共接受了34次解除梗阻手术（平均每位患者1.7次手术；范围为1至3次）；28例为内镜手术，6例为开放性前列腺切除术。其中1例因膀胱顺应性严重低下曾行回肠膀胱扩大术。10例完全失禁，使用阴茎套导管（7例）、阴茎夹（2例）或永久性留置导尿管（1例）。其余患者平均每天使用3.7片尿垫。B组包括11名有复杂泌尿系统病史的男性：9例有神经源性功能障碍，1例有膀胱外翻，1例曾行膀胱切除术并采用Studer新膀胱。8例使用阴茎套导管。8例（4至4.5厘米）将袖带置于球部尿道，4例（9至10厘米）置于膀胱颈。C组包括9例既往干预失败后的Ⅲ型压力性尿失禁女性患者（范围为1至4次，平均2.7次）。所有这些患者每天至少需要3片尿垫（平均4.5片）。袖带置于膀胱颈，直径范围为5至10厘米。
平均随访28.5个月（范围为8至96个月）。1例患者在人工括约肌植入两年后死亡，该括约肌从未激活。在A组中，83%的患者在社交场合能保持控尿，17例不需要使用尿垫。20例植入人工括约肌的患者中有3例共接受了4次手术翻修。在B组中，社交控尿率为63%，翻修率为36%。4例患者需要完全更换系统。在C组中，翻修后的控尿率为66%。1例患者连续两次成功翻修，3例需要取出装置，失败率为33%。3名女性和5名男性需要最终取出人工尿道括约肌。除1名男性拒绝再次植入外，其余患者被认为不适合使用新装置。6例患者至少接受了一次再次手术以更换系统的一个或多个部件。翻修后66%的患者恢复了控尿功能。
人工尿道括约肌在重度失禁患者中能取得良好的控尿率，尽管需要对患者进行仔细的随访。
