Reynolds W Stuart, Patel Riddhi, Msezane Lambda, Lucioni Alvaro, Rapp David E, Bales Gregory T
University of Chicago, Chicago, Illinois, USA.
J Urol. 2007 Aug;178(2):578-83. doi: 10.1016/j.juro.2007.03.146. Epub 2007 Jun 14.
Significant improvement and high patient satisfaction are seen after artificial urinary sphincter implantation for male stress urinary incontinence. However, only a small percent of men are treated with an artificial urinary sphincter nationally. We defined trends in current artificial urinary sphincter use in the United States, specifically focusing on regional differences in use. Current rates of radical prostatectomy and the regional distribution of urologists were analyzed as possible factors to explain these disparities.
Data provided by American Medical Systems, Minnetonka, Minnesota on the number of artificial urinary sphincter units sold were analyzed by state, regional and city distribution. American Urological Association data on the number of urologists were used to estimate urologist use of artificial urinary sphincters. The number of radical prostatectomies reported by the American College of Surgeons National Cancer Database were used to estimate artificial urinary sphincter use per radical prostatectomy.
In the most populous states and cities generally the most artificial urinary sphincter units were purchased, the most urologists were reported and the most radical prostatectomies were performed. The proportional use of artificial urinary sphincters per radical prostatectomy by state varied from 1% to 10% (national average approximately 6%). The number of urologists per 100,000 men older than 50 years appeared uniform across states (national average 34). However, artificial urinary sphincter use by urologist appeared localized and concentrated. Nationally 1 artificial urinary sphincter unit was purchased for every 3 urologists in the United States.
Artificial urinary sphincter use demonstrates considerable state and regional variation even when controlled for differences in the frequency of radical prostatectomy and the distribution of urologists. Overall the data suggest that artificial urinary sphincters may be underused in some areas of the country, particularly for post-prostatectomy incontinence.
人工尿道括约肌植入术治疗男性压力性尿失禁后，患者情况有显著改善且满意度较高。然而，在全国范围内，仅有一小部分男性接受了人工尿道括约肌治疗。我们确定了美国目前人工尿道括约肌的使用趋势，特别关注使用情况的地区差异。分析了当前根治性前列腺切除术的发生率以及泌尿科医生的地区分布情况，将其作为解释这些差异的可能因素。
分析了明尼苏达州明尼通卡市美国医疗系统公司提供的关于人工尿道括约肌装置销售数量的数据，按州、地区和城市分布进行分析。利用美国泌尿外科学会关于泌尿科医生数量的数据来估计泌尿科医生对人工尿道括约肌的使用情况。采用美国外科医师学会国家癌症数据库报告的根治性前列腺切除术数量来估计每例根治性前列腺切除术后人工尿道括约肌的使用情况。
在人口最多的州和城市，通常购买的人工尿道括约肌装置最多，报告的泌尿科医生最多，进行的根治性前列腺切除术也最多。各州每例根治性前列腺切除术后人工尿道括约肌的使用比例从1%到10%不等（全国平均约为6%）。各州每10万名50岁以上男性中的泌尿科医生数量似乎较为一致（全国平均为34名）。然而，泌尿科医生对人工尿道括约肌的使用似乎具有局部性和集中性。在全国范围内，美国每3名泌尿科医生购买1个人工尿道括约肌装置。
即使在控制了根治性前列腺切除术频率差异和泌尿科医生分布的情况下，人工尿道括约肌的使用仍存在显著的州和地区差异。总体而言，数据表明该国某些地区可能未充分使用人工尿道括约肌，尤其是在前列腺切除术后尿失禁的治疗方面。
