Aprikian A, Berardinucci G, Pike J, Kiruluta G
Department of Surgery, Montreal Children's Hospital, McGill University, Que.
Can J Surg. 1992 Aug;35(4):396-400.
The authors describe their experience with an artificial urinary sphincter (model AS-800; American Medical Systems, Minnetonka, Minn.) in treating urinary incontinence in children. Twenty-eight sphincters were implanted in 27 boys between May 1986 and June 1989. All the boys had neurogenic bladders secondary to myelomeningocele or sacral agenesis. The mean age at the time of initial implantation was 14 years (range from 9 to 19 years), and the median follow-up was 12 months (range from 6 to 31 months). The sphincters were implanted initially around the bladder neck in 25 cases. Three required reimplantation around the bulbous urethra. The complication rate was 39% (11 of 28 cases). There were two cases of erosion, two cases of infection without erosion and seven cases of device-related problems. The artificial sphincter had to be removed in four cases. There were no deaths. The revision rate was 25% (7 of 28 cases). Continence was evaluated in 22 (88%) of 25 boys who had functional sphincters in place. Five boys required oxybutinin chloride to maintain continence. Ten boys required augmentation cystoplasty before (3), after (6) and combined with (1) sphincter implantation. Eight of these 10 children were able to void spontaneously and were continent. One required intermittent catheterization twice a day and another six times a day. The authors conclude from their experience that the artificial urinary sphincter (model AS-800) can establish continence in boys with neurogenic bladders. Proper selection of the ideal patient for the artificial sphincter is essential to avoid complications.
作者描述了他们使用人工尿道括约肌（AS - 800型；美国医疗系统公司，明尼苏达州明尼通卡）治疗儿童尿失禁的经验。1986年5月至1989年6月期间，27名男孩植入了28个括约肌。所有男孩均患有继发于脊髓脊膜膨出或骶骨发育不全的神经源性膀胱。初次植入时的平均年龄为14岁（9至19岁），中位随访时间为12个月（6至31个月）。25例最初将括约肌植入膀胱颈周围。3例需要在球部尿道周围重新植入。并发症发生率为39%（28例中的11例）。有2例侵蚀，2例无侵蚀的感染以及7例与装置相关的问题。4例不得不取出人工括约肌。无死亡病例。翻修率为25%（28例中的7例）。对25名拥有功能性括约肌的男孩中的22名（88%）进行了尿失禁评估。5名男孩需要使用氯化奥昔布宁来维持尿失禁。10名男孩在括约肌植入前（3例）、后（6例）以及联合（1例）植入时需要进行膀胱扩大术。这10名儿童中有8名能够自主排尿且保持尿失禁。1名需要每天进行两次间歇性导尿，另1名需要每天进行六次。作者根据他们的经验得出结论，人工尿道括约肌（AS - 800型）可以使患有神经源性膀胱的男孩实现尿失禁。正确选择人工括约肌的理想患者对于避免并发症至关重要。
