Service d'Urologie, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Université Paris-VI, Paris, France.
BJU Int. 2011 Feb;107(3):426-32. doi: 10.1111/j.1464-410X.2010.09501.x.
To assess results and morbidity of the periprostatic insertion of an artificial urinary sphincter (AUS) in adult male patients with a neurogenic bladder.
A retrospective study was carried out on 51 adult male patients operated on in four urologic academic wards from April 1988 to January 2008. Among these patients, 31% (16/51) had spina bifida and 69% (35/51) had spinal cord injury. All patients suffered urinary incontinence secondary to sphincteric deficiency, and this was associated with detrusor overactivity in 39% of them (leading in these cases to an added bladder augmentation). Perfect continence was defined as a period of dryness of at least 4 h between two self-intermittent catheterizations (SIC) or spontaneous micturitions, moderate incontinence as nocturnal leakage or need to wear protection once during the day or for stress leakage, while severe incontinence was defined as uncontrollable leakage causing patient discomfort.
Mean age at the procedure was 35 years (18-58). Mean follow-up was 83 months (CI 95%, 65-101). At the end of the study, 15 patients (29.4%) were lost to follow-up. One patient (2%) died shortly after the procedure from a pulmonary infection. Post-operative morbidity was observed in 19% (10/50) of the patients (8 urinary tract infection, 1 failure to perform SIC, 1intracranial hypertension). Of the patients in our study 74% had perfect or moderate continence with a working AUS after a 10-year follow-up
We present a specific study on adult patients with a neurological lesion leading to bladder dysfunction treated by a periprostatic AUS. This procedure was effective in restoring urinary incontinence in the vast majority of our patients with an acceptable morbidity.
评估经前列腺置入人工尿道括约肌（AUS）治疗神经源性膀胱成年男性患者的效果和发病率。
对 1988 年 4 月至 2008 年 1 月在四个泌尿科病房接受手术的 51 例成年男性患者进行了回顾性研究。其中 31%（16/51）为脊膜膨出，69%（35/51）为脊髓损伤。所有患者均因括约肌缺陷导致尿失禁，39%的患者存在逼尿肌过度活动（导致这些患者需要额外进行膀胱扩张）。完全控尿定义为两次间歇性导尿（SIC）或自发性排尿之间至少 4 小时无尿失禁；中度尿失禁定义为夜间漏尿或白天需要佩戴防护用具 1 次或因压力性漏尿；严重尿失禁定义为无法控制的漏尿导致患者不适。
手术时的平均年龄为 35 岁（18-58 岁）。平均随访时间为 83 个月（95%CI，65-101）。研究结束时，15 例患者（29.4%）失访。1 例患者（2%）术后因肺部感染不久死亡。术后并发症发生率为 19%（10/50），包括 8 例尿路感染、1 例 SIC 失败和 1 例颅内压升高。在我们的研究中，74%的患者在 10 年随访后拥有完美或中度的控尿功能和正常工作的 AUS。
我们对因神经病变导致膀胱功能障碍而接受经前列腺 AUS 治疗的成年患者进行了一项专门研究。该手术在恢复尿失禁方面对绝大多数患者有效，且发病率可接受。
