Catti M, Lortat-Jacob S, Morineau M, Lottmann H
Service de Chirurgie Infantile, Professor Yann Revillon, Hôpital Necker-Enfants Malades, Paris, France.
J Urol. 2008 Aug;180(2):690-3; discussion 693. doi: 10.1016/j.juro.2008.04.039. Epub 2008 Jun 13.
We evaluated functional results with an artificial urinary sphincter in children and adolescents in terms of complications, continence and voiding ability through followup.
A total of 44 patients (39 males and 5 females, age 8.6 to 29.5 years, median 14) underwent implantation of a pericervical AMS 800trade mark artificial urinary sphincter, primarily for severe urinary incontinence of neuropathic origin, between 1986 and 2005. Of the patients 25 had undergone augmentation cystoplasty previously (8), simultaneously (7) or after implantation (10). Median followup was 5.5 years (range 1 to 18). Complications included dysuria and/or urinary retention (24 cases), worsening of bladder function (13), urethral erosion (2), scrotal erosion (5), mechanical dysfunction (7), infection of the artificial urinary sphincter (2) and accidental puncture of the tubes (2). These complications resulted in 9 removals, 5 deactivations, 6 revisions and 5 total replacements.
Of 44 patients 9 (20%) were incontinent after removal of the artificial urinary sphincter. Among the remaining patients 32 (73%) were dry and 3 (7%) were incontinent with a deactivated device. Of the 35 patients with an artificial urinary sphincter in place 17 (48.6%) voided to completion with spontaneous voiding, 9 (25.7%) performed post-void clean intermittent catheterization and 9 (25.7%) emptied exclusively with clean intermittent catheterization. The ability to maintain voiding to completion after implantation was significantly decreased when the artificial urinary sphincter was implanted before puberty (p = 0.0025) or in conjunction with an augmented bladder (p = 0.01).
The artificial urinary sphincter provides a good rate of continence. However, complications are frequent, leading to removal in 20% of the cases. In time only a limited number of patients can empty the bladder without clean intermittent catheterization.
我们通过随访评估了儿童和青少年人工尿道括约肌的功能结果，包括并发症、控尿能力和排尿能力。
1986年至2005年间，共有44例患者（39例男性，5例女性，年龄8.6至29.5岁，中位年龄14岁）接受了颈周AMS 800商标人工尿道括约肌植入术，主要用于治疗神经性重度尿失禁。其中25例患者先前（8例）、同时（7例）或植入后（10例）接受了膀胱扩大术。中位随访时间为5.5年（范围1至18年）。并发症包括排尿困难和/或尿潴留（24例）、膀胱功能恶化（13例）、尿道糜烂（2例）、阴囊糜烂（5例）、机械功能障碍（7例）、人工尿道括约肌感染（2例）和导管意外穿刺（2例）。这些并发症导致9例移除、停用5例、6例修复和5例全部更换。
44例患者中，9例（20%）在移除人工尿道括约肌后仍失禁。其余患者中，32例（73%）无尿失禁，3例（7%）在装置停用后仍失禁。在35例使用人工尿道括约肌的患者中，17例（48.6%）能自主排尿至排空，9例（25.7%）排尿后需进行清洁间歇性导尿，9例（25.7%）完全依靠清洁间歇性导尿排空膀胱。青春期前植入人工尿道括约肌（p = 0.0025）或与扩大膀胱联合植入（p = 0.01）时，植入后维持排尿至排空的能力显著降低。
人工尿道括约肌的控尿率良好。然而，并发症频发，导致20%的病例需要移除装置。随着时间推移，只有少数患者能够在不进行清洁间歇性导尿的情况下排空膀胱。
