Lee Richard, Te Alexis E, Kaplan Steven A, Sandhu Jaspreet S
Division of Urology, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York 10065, USA.
J Urol. 2009 Jun;181(6):2622-7. doi: 10.1016/j.juro.2009.01.113. Epub 2009 Apr 16.
The introduction of the artificial urinary sphincter represented a significant advance in treating urinary incontinence. We examined temporal trends in artificial urinary sphincter use, focusing on adoption of the device with time, individual surgeon volume, indications for placement and differences in application by gender.
Data on artificial urinary sphincter related operations performed in the United States from 1975 and thereafter were provided by the manufacturer. Surgical and demographic data on each patient were recorded and analyzed on an annual basis at 5-year intervals to determine the number of procedures performed as well as individual surgeon volume. Indications for implantation or revision were also studied and recorded in 5-year increments.
Artificial urinary sphincter use increased dramatically from 11 cases in 1975 to 3,762 in 2005. Most increased volume was due to an increase in device use in men with little growth in use in women. More than 90% of surgeons who participated in artificial urinary sphincter surgery performed 5 or fewer related cases per year (median 1 to 2) in most years. The annual proportion of revision surgeries stabilized after an initial increase. The most prevalent indication for initial implantation in men from 1985 and thereafter was incontinence after radical prostatectomy. In women neurogenic disease was consistently the most common indication for placement.
Artificial urinary sphincter use has increased dramatically in the United States since 1975 and it now appears to be stable. Placement is primarily performed in men with incontinence after radical prostatectomy. Only a small minority of surgeons perform a high volume of artificial urinary sphincter cases.
人工尿道括约肌的引入是治疗尿失禁的一项重大进展。我们研究了人工尿道括约肌使用的时间趋势，重点关注该装置随时间的采用情况、个体外科医生的手术量、植入指征以及不同性别的应用差异。
制造商提供了1975年及之后在美国进行的与人工尿道括约肌相关手术的数据。每年以5年为间隔记录并分析每位患者的手术和人口统计学数据，以确定手术例数以及个体外科医生的手术量。植入或翻修的指征也以5年为增量进行研究和记录。
人工尿道括约肌的使用从1975年的11例急剧增加到2005年的3762例。增加的大部分手术量是由于男性使用该装置的增加，而女性使用量增长很少。在大多数年份，参与人工尿道括约肌手术的外科医生中，超过90%每年进行5例或更少的相关手术（中位数为1至2例）。翻修手术的年度比例在最初增加后趋于稳定。1985年及之后，男性初次植入最常见的指征是根治性前列腺切除术后尿失禁。在女性中，神经源性疾病一直是最常见的植入指征。
自1975年以来，美国人工尿道括约肌的使用急剧增加，目前似乎趋于稳定。植入主要针对根治性前列腺切除术后尿失禁的男性。只有少数外科医生进行大量的人工尿道括约肌手术。
