Costa P, Mottet N, Rabut B, Thuret R, Ben Naoum K, Wagner L
Service D'Urologie-Andrologie, Centre Hospitalier Universitaire de Nimes, Montpellier, France.
J Urol. 2001 Apr;165(4):1172-6.
We evaluate the efficacy of the AMS 800 artificial urinary sphincter in women with type III incontinence.
We enrolled 207 women with genuine stress incontinence due to intrinsic sphincter deficiency. Primary inclusion criterion was a negative Marshall test. A modified surgical procedure was used to implant the AMS 800 through an abdominal approach, with placement of the cuff around the bladder neck between the periurethral fascia and vagina. Followup data were available for 206 women, including 179 with nonneurogenic and 27 with neurogenic bladders (mean followup 3.9 years).
There were 12 (5.9%) explantations due to the prosthesis either through an erosion, extrusion or both that were necessary. The only significant risk factor for explantation was perioperative injury. This injury resulted in 8 explantations in 49 patients compared with 4 in 155 who did not have such injuries (p = 0.0016). Of the 190 patients with working devices continence was achieved in 88.7% (49 of 168) and 81.8% (18 of 22) of those with nonneurogenic and neurogenic bladders, respectively. Social continence (slight leakage but no pad use) was reported by 7.7% (13 of 168) and 9.1% (2 of 22) of patients in the nonneurogenic and neurogenic groups, respectively. The remaining patients reported leakage and pad use.
The AMS 800 can be used successfully to treat women with genuine stress incontinence due to intrinsic sphincter deficiency. The modified surgical approach resulted in fewer perioperative injuries and, consequently, a low explantation rate. Women with genuine stress incontinence, a low urethral closure pressure and negative Marshall test indicating severe intrinsic sphincter deficiency are potential candidates for artificial urinary sphincter implantation.
我们评估 AMS 800 人工尿道括约肌对Ⅲ型尿失禁女性患者的疗效。
我们纳入了 207 例因内在括约肌缺陷导致真性压力性尿失禁的女性患者。主要纳入标准为马歇尔试验阴性。采用改良手术方法经腹部途径植入 AMS 800，将袖带置于膀胱颈周围的尿道周围筋膜和阴道之间。206 例女性患者有随访数据，其中 179 例为非神经源性膀胱，27 例为神经源性膀胱（平均随访 3.9 年）。
因假体出现侵蚀、挤压或两者皆有而进行了 12 例（5.9%）取出术。取出假体的唯一显著危险因素是围手术期损伤。该损伤导致 49 例患者中有 8 例取出假体，而未发生此类损伤的 155 例患者中有 4 例取出假体（p = 0.0016）。在 190 例装置正常工作的患者中，非神经源性膀胱患者和神经源性膀胱患者分别有 88.7%（168 例中的 49 例）和 81.8%（22 例中的 18 例）实现了控尿。非神经源性组和神经源性组分别有 7.7%（168 例中的 13 例）和 9.1%（22 例中的 2 例）的患者报告达到了社会控尿（轻微漏尿但无需使用尿垫）。其余患者报告有漏尿并使用尿垫。
AMS 800 可成功用于治疗因内在括约肌缺陷导致真性压力性尿失禁的女性患者。改良手术方法减少了围手术期损伤，因此取出率较低。真性压力性尿失禁、尿道闭合压较低且马歇尔试验阴性表明存在严重内在括约肌缺陷的女性是人工尿道括约肌植入的潜在候选者。
