Reconstructive and Neurourology, Kaiser Permanente Medical Center, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA 90027, USA.
World J Urol. 2011 Apr;29(2):249-53. doi: 10.1007/s00345-010-0589-4. Epub 2010 Oct 20.
Treatment of recurrent stress incontinence after a failed surgical procedure is more complicated, and repeat surgeries have higher rates of complications and limited efficacy. We determined the technical feasibility, efficacy, adjustability, and safety of adjustable continence therapy device for treatment of moderate to severe recurrent urinary incontinence after failed surgical procedure.
Female patients with moderate to severe recurrent stress urinary incontinence who had at least one prior surgical procedure for incontinence were enrolled. All patients underwent percutaneous placement of adjustable continence therapy (ACT) device (Uromedica, Plymouth, Minnesota). Baseline and regular follow-up tests to determine subjective and objective improvement were performed.
A total of 89 patients have undergone implantation with 1-3 years of follow-up. Data are available on 77 patients at 1 year. Of the patients, 47% were dry at 1 year and 92% improved after 1-year follow-up. Stamey score improved from 2.25 to 0.94 at 1 year (P < 0.001). IQOL questionnaire scores improved from 33.9 to 71.6 at 1 year (P < 0.001). UDI scores reduced from 60.7 to 33.3 (P < 0.001) at 1 year. IIQ scores reduced from 57.0 to 21.6 (P < 0.001) at 1 year. Diary incontinence episodes per day improved from 8.1 to 3.9 (P < 0.001) at 1 year. Diary pads used per day improved from 4.3 to 1.9 (P < 0.001). Explantation was required in 21.7% of patients.
The ACT device is an effective, simple, safe, and minimally invasive treatment for moderate to severe recurrent female stress urinary incontinence after failed surgical treatment.
治疗手术失败后复发性压力性尿失禁更为复杂，再次手术的并发症发生率更高，疗效有限。我们确定了可调性控尿治疗装置（ACT 装置）治疗手术失败后中重度复发性尿失禁的技术可行性、疗效、可调节性和安全性。
入组患者为至少有一次治疗压力性尿失禁手术失败的中重度复发性压力性尿失禁女性患者。所有患者均行经皮植入 ACT 装置（Uromedica，明尼苏达州普利茅斯）。进行基线和定期随访检查以确定主观和客观改善情况。
共 89 例患者接受了植入术，随访时间为 1-3 年。77 例患者在 1 年时可获得数据。1 年后，患者中有 47%完全缓解，92%患者在 1 年随访后改善。Stamey 评分从 1 年时的 2.25 分改善至 0.94 分（P < 0.001）。1 年时，IQOL 问卷评分从 33.9 分改善至 71.6 分（P < 0.001）。1 年时，UDI 评分从 60.7 分降至 33.3 分（P < 0.001）。1 年时，IIQ 评分从 57.0 分降至 21.6 分（P < 0.001）。1 年时，每日尿失禁日记记录事件从 8.1 次减少至 3.9 次（P < 0.001）。1 年时，每日尿垫使用量从 4.3 片减少至 1.9 片（P < 0.001）。21.7%的患者需要取出装置。
ACT 装置是一种有效、简单、安全且微创的治疗手术失败后中重度复发性女性压力性尿失禁的方法。
