Mouracade P, Wagner B, Charles T, Lang H, Jacqmin D, Saussine C
Service d'urologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
Prog Urol. 2008 Jun;18(6):390-4. doi: 10.1016/j.purol.2008.02.003. Epub 2008 Apr 23.
To evaluate the results of treatment of postoperative male stress urinary incontinence by placement of an AMS Invance bone-anchored male sling (BAMS).
Between February 2005 and May 2007, 29 patients with stress urinary incontinence secondary to prostatic surgery were treated by Invance bone-anchored male sling. This BAMS consists of a silicone-coated polyester sling placed around the bulbar urethra and anchored to the ischiopubic rami by six titanium screws. According to the number of protections used per 24 hour, patients were considered to present mild (one to two), moderate (three to four) or severe (five or more, or penile sheath) incontinence. The number of protections, the continence rate and early and late complications were reported. Success or continence was defined by the absence of urine leaks and protections.
The mean age of the patients of this series was 67.5 years. Incontinence was mild for 12 patients (41.4%), moderate for six patients (20.7%) and severe for 11 patients (37.9%). The mean interval between prostatic surgery and BAMS placement was 47.9 months. The mean operating time was 65.8 minutes. There were no intraoperative complications. Two cases (7%) of spontaneously resolving acute urinary retention were observed. Explantation of the BAMS for chronic perineal pain or operative site infection was performed in five patients (17%) after a mean interval of 4.1 months (range: 1-8.5 months). The revision rate for repositioning of the screws was 10.3% (three patients). The continence rate at three months was 62.5%. After a mean follow-up of 11.5 months, this rate was 37.5%, corresponding to 77.8% of patients with initially mild or moderate incontinence and 22.2% with severe incontinence. Residual incontinence was mild in 41.7%, moderate in 8.3% and severe in 12.5%. Four patients with persistent urinary incontinence after BAMS placement were treated by artificial urinary sphincter.
Bone-anchored male sling is a minimally invasive treatment for postoperative male urinary incontinence, but is associated with significant morbidity (five explanations in a series of 29 patients). Better results were obtained for mild to moderate incontinence.
评估采用AMS Invance骨锚定男性吊带（BAMS）治疗男性术后压力性尿失禁的效果。
2005年2月至2007年5月期间，对29例前列腺手术后继发压力性尿失禁的患者采用Invance骨锚定男性吊带进行治疗。该BAMS由一条包裹在球部尿道周围的硅胶涂层聚酯吊带组成，并通过六颗钛螺钉固定于耻骨支。根据每24小时使用的护垫数量，将患者分为轻度（1 - 2片）、中度（3 - 4片）或重度（5片及以上，或阴茎套）尿失禁。报告护垫数量、控尿率以及早期和晚期并发症。成功或控尿定义为无尿液渗漏且无需使用护垫。
该系列患者的平均年龄为67.5岁。12例患者（41.4%）为轻度尿失禁，6例患者（20.7%）为中度尿失禁，11例患者（37.9%）为重度尿失禁。前列腺手术与放置BAMS之间的平均间隔时间为47.9个月。平均手术时间为65.8分钟。术中无并发症发生。观察到2例（7%）患者出现自发性急性尿潴留并自行缓解。5例患者（17%）在平均4.1个月（范围：1 - 8.5个月）后因慢性会阴部疼痛或手术部位感染而取出BAMS。螺钉重新定位的翻修率为10.3%（3例患者）。三个月时的控尿率为62.5%。平均随访11.5个月后，该比率为37.5%，其中最初为轻度或中度尿失禁的患者占77.8%，重度尿失禁的患者占22.2%。残余尿失禁轻度占41.7%，中度占8.3%，重度占12.5%。4例BAMS放置后仍持续尿失禁的患者接受了人工尿道括约肌治疗。
骨锚定男性吊带是治疗男性术后尿失禁的一种微创方法，但存在显著的发病率（29例患者中有5例出现相关情况）。对于轻度至中度尿失禁患者，效果更佳。
