Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine and St. Louis Veterans Affairs Medical Center, St. Louis, Missouri 63110, USA.
J Urol. 2012 Mar;187(3):951-5. doi: 10.1016/j.juro.2011.10.153. Epub 2012 Jan 20.
We compared artificial urinary sphincter complication rates, overall reoperative rates, and continence results in virgin cases, revision cases and secondary reimplant cases (with prior erosion or infection).
Only male patients with post-prostatectomy stress incontinence with AMS 800™ placement in the bulbar urethra by a single surgeon were included in the study. A total of 169 virgin cases (no prior artificial urinary sphincter surgery), 37 revision cases (eg cuff revision for urethral atrophy, revision of failed components) and 21 secondary reimplant cases (eg after prior explant from urethral erosion or infection) were compared.
Secondary artificial urinary sphincter reimplant cases (eg after prior explant from urethral erosion or infection) had fourfold higher future erosion rates compared to virgin cases (p = 0.02, 14.3% vs 3.6%, RR 4.02). In addition, there was no difference in the rates of other complications (device infection, urethral atrophy, mechanical failure, leaks), overall reoperation rates and postoperative continence outcomes (measured by daily pad use) compared to virgin cases. Artificial urinary sphincter revision cases did not have higher complication rates (including subsequent urethral erosion), reoperation rates or worse postoperative continence outcomes compared to virgin cases. Although the difference was not statistically significant, a trend toward higher future device leak rates (10.8% vs 3.6%, RR 3.05, p = 0.063) and higher urethral atrophy rates (16.2% vs 8.9%, RR 1.83, p = 0.18) was noted in artificial urinary sphincter revision cases compared to virgin implant cases.
Patients with a history of artificial urinary sphincter explant have a fourfold increased risk of future cuff erosion. Nevertheless, a good functional outcome with an acceptable complication rate may be achieved in most complex reoperative artificial urinary sphincter cases.
我们比较了初次植入、翻修手术和二次再植入（先前有过尿道侵蚀或感染）患者的人工尿道括约肌并发症发生率、总再手术率和控尿效果。
本研究仅纳入了由同一位外科医生在球部尿道使用 AMS 800™ 进行前列腺切除术后压力性尿失禁治疗的男性患者。共纳入 169 例初次植入病例（无先前人工尿道括约肌手术史）、37 例翻修病例（如因尿道萎缩进行袖套翻修、更换失效部件）和 21 例二次再植入病例（如先前因尿道侵蚀或感染而取出）。
与初次植入病例相比，二次再植入病例（如先前因尿道侵蚀或感染而取出）未来发生侵蚀的风险高 4 倍（p = 0.02，14.3%比 3.6%，RR 4.02）。此外，与初次植入病例相比，两组在其他并发症（装置感染、尿道萎缩、机械故障、漏尿）发生率、总再手术率和术后控尿效果（以每日使用尿垫量衡量）方面均无差异。与初次植入病例相比，人工尿道括约肌翻修病例的并发症发生率（包括随后的尿道侵蚀）、再手术率或术后控尿效果并无更高。尽管差异无统计学意义，但人工尿道括约肌翻修病例未来发生装置漏尿的风险（10.8%比 3.6%，RR 3.05，p = 0.063）和尿道萎缩的风险（16.2%比 8.9%，RR 1.83，p = 0.18）有增高趋势。
有过人工尿道括约肌取出史的患者未来发生袖套侵蚀的风险增加 4 倍。然而，在大多数复杂的再手术人工尿道括约肌病例中，仍可获得良好的功能效果和可接受的并发症发生率。
