Department of Surgery, University of Toledo, Toledo, Ohio, USA.
Urology. 2012 Apr;79(4):922-8. doi: 10.1016/j.urology.2011.11.051. Epub 2012 Feb 4.
To assess our institutional outcomes after primary artificial urinary sphincter (AUS) failures.
From 1985 to 2010, a total of 149 patients underwent 318 primary and additional AUS procedures. We classified additional procedures as revisions, replacements, or explantations.
At a median of 52 months (range, 6-250 months), 53% of patients had required at least 1 additional procedure beyond their initial implantation. These included 106 (63%) revisions, 42 (24.9%) explantations, and 21 (12.4%) replacements. The most common revision was reservoir upsizing (37/106). Reasons for first revision included recurrent incontinence (56.7%), mechanical malfunction (22%), and infection or erosion (18.6%). Explantations were performed primarily for infection and erosion (64.3%). Median time to first revision was 20.1 months (range, 0.1-173 months) after implantation, with a median of 9.5 months (range, 1-102 months) between revisions. Explantation occurred at a median of 22 months (range, 1-221 months) after implant, and subsequent replacement at a median of 33.6 months (range, 2-138 months). At 5 years, 28/83 (33.7%) patients had undergone no additional procedures. Patients with previous radiation were more likely to experience infection (P = .03; OR 3.99; 95% CI 1.03-15.42). Patients with previous myocardial infarction were more likely to experience erosion (P = .04; OR 2.29; 95% CI 1.05-5.02), and obese patients were more likely to experience mechanical malfunction (P = .04; OR 2.62; 95% CI 1.07-6.4).
More than half of patients with an AUS will require additional procedures, most likely revision. Radiation, previous myocardial infarction, and obesity are linked to complications. Median time to first revision or explantation is slightly less than 2 years, indicating that long-term follow-up is required after initial implantation.
评估我们在初次人工尿控括约肌（AUS）失败后的治疗效果。
1985 年至 2010 年，共有 149 例患者接受了 318 例初次和附加 AUS 手术。我们将附加手术分为翻修术、置换术和取出术。
中位随访时间为 52 个月（范围：6-250 个月），53%的患者在初次植入后至少需要进行 1 次附加手术。这些患者包括 106 例（63%）翻修术、42 例（24.9%）取出术和 21 例（12.4%）置换术。最常见的翻修术是储尿囊增大术（37/106）。初次翻修的原因包括复发性尿失禁（56.7%）、机械故障（22%）和感染或侵蚀（18.6%）。取出术主要是由于感染和侵蚀（64.3%）。初次植入后 20.1 个月（范围：0.1-173 个月）时进行首次翻修，翻修之间的中位时间为 9.5 个月（范围：1-102 个月）。植入后 22 个月（范围：1-221 个月）时进行取出术，植入后 33.6 个月（范围：2-138 个月）时进行再次置换术。5 年时，83 例患者中有 28 例未进行其他附加手术。有既往放疗史的患者更易发生感染（P=0.03；OR 3.99；95%CI 1.03-15.42）。有既往心肌梗死史的患者更易发生侵蚀（P=0.04；OR 2.29；95%CI 1.05-5.02），肥胖患者更易发生机械故障（P=0.04；OR 2.62；95%CI 1.07-6.4）。
超过一半的 AUS 患者需要进行附加手术，最常见的是翻修术。放疗、既往心肌梗死和肥胖与并发症相关。初次翻修或取出的中位时间略低于 2 年，这表明初次植入后需要长期随访。
