Department of Urology, Clinique Chirurgicale du Pre, Le Mans, France.
BJU Int. 2010 Oct;106(8):1194-8; discussion 1198. doi: 10.1111/j.1464-410X.2010.09206.x.
to assess the safety, feasibility and efficacy of laparoscopic implantation of the artificial urinary sphincter (AUS) in women with genuine stress urinary incontinence (SUI).
from April 2005 to July 2009, 25 women (mean age 66.8 years) with genuine SUI had a laparoscopic implantation of the AUS (AMS 800(TM) , American Medical Systems, Minnetonka, MN, USA). Patients had a negative Marshall test and urodynamic studies showed decreased closure pressure. All patients had a history of urogynaecological surgery. Transperitoneal laparoscopic access was created with two midline 10-mm and two lateral 5-mm trocars. One of the lateral port incisions was later extended to facilitate urethrovaginal dissection with scissors and dissector, and the insertion and assembly of the AUS. In six cases of concomitant genito-urinary prolapse, laparoscopic anterior and posterior mesh promontofixation was also performed.
the AUS was successfully implanted in all cases with no conversion to open surgery. There were no intra- or perioperative complications, except one vaginal perforation which was repaired during surgery. The mean operative duration was 92 min (71 min without and 123 min with simultaneous promontofixation). Five patients developed urinary retention, which was managed with re-insertion of the urethral catheter for 2 days in four and with insertion of a suprapubic catheter for 4 weeks in a patient with spina bifida. During the mean follow-up of 26.1 months, two treatment failures were diagnosed due to vaginal erosion and were managed with removal of the AUS. All the remaining 23 patients reported continence, either complete (in 19) or social (in four). However, this was not a randomized comparative study.
laparoscopic implantation of the AUS in women with genuine SUI is safe, feasible and efficient.
评估腹腔镜植入人工尿道括约肌（AUS）治疗真性压力性尿失禁（SUI）女性的安全性、可行性和疗效。
2005 年 4 月至 2009 年 7 月，25 例真性 SUI 女性（平均年龄 66.8 岁）接受了腹腔镜 AUS 植入术（AMS 800(TM)，美国医学系统公司，明尼苏达州明尼通卡）。患者 Marshall 试验均为阴性，尿动力学研究显示尿道关闭压降低。所有患者均有妇科泌尿手术史。采用经腹腹腔镜入路，建立两个正中 10mm 和两个侧方 5mm 套管。其中一个侧方切口后来延长，以便用剪刀和剥离器进行尿道阴道解剖，并插入和组装 AUS。在 6 例合并生殖泌尿系统脱垂的患者中，还进行了腹腔镜前路和后路网片固定术。
所有病例均成功植入 AUS，无中转开放手术。无术中或围手术期并发症，除 1 例阴道穿孔，术中修复。平均手术时间为 92 分钟（无同时固定术为 71 分钟，有同时固定术为 123 分钟）。5 例患者发生尿潴留，4 例经重新插入导尿管 2 天，1 例合并脊膜膨出患者经插入耻骨上导管 4 周后得到缓解。在平均 26.1 个月的随访中，2 例因阴道侵蚀而诊断为治疗失败，并采用移除 AUS 进行治疗。其余 23 例患者均报告有尿控，完全（19 例）或社交（4 例）。然而，这并不是一项随机对照研究。
腹腔镜植入 AUS 治疗真性 SUI 女性安全、可行且有效。
