Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Eur Urol. 2013 Apr;63(4):681-9. doi: 10.1016/j.eururo.2012.11.034. Epub 2012 Nov 23.
The artificial urinary sphincter (AUS) has historically been considered the gold standard for the surgical management of non-neurogenic stress urinary incontinence (SUI) in men. As new surgical alternatives attempt to offer alternatives to treat male SUI, a contemporary assessment of the evidence supporting the use of AUS appears mandatory for clinical decision making.
To conduct a critical systematic review of long-term outcomes after AUS implantation in male patients with non-neurogenic SUI.
A literature search was conducted in PubMed/Medline and Embase databases using the keywords urinary incontinence and urinary sphincter, artificial and male, restricted to articles published in Dutch, English, French, and German between 1989 and 2011. Studies were included if they reported outcomes after AUS implantation in patients with non-neurogenic SUI with a minimum follow-up of 2 yr. Studies with heterogeneous populations were included if information about non-neurogenic patients was displayed separately.
Twelve reports were identified, gathering data about 623 patients. Only three studies were prospective. Continence, evaluated only by patient-reported pad use and various questionnaires, was achieved in 61-100% of cases (no pad or one pad per day). Dry rates (no pad) were only available in seven studies and varied from 4% to 86%. A pooled analysis showed that infection or erosion occurred in 8.5% of cases (3.3-27.8%), mechanical failure in 6.2% of cases (2.0-13.8%), and urethral atrophy in 7.9% (1.9-28.6%). Reoperation rate was 26.0% (14.8-44.8%). Patient satisfaction was evaluated in four studies with four different tools and seems to improve after AUS implantation.
Quality of evidence supporting the use of AUS in non-neurogenic male patients with SUI is low, based on heterogeneous data, low-quality studies, and mostly out-of-date efficacy outcome criteria. AUS outcomes need to be revisited to be compared with new surgical alternatives, all of which should be prospectively evaluated according to current evidence-based medicine standards.
人工尿道括约肌（AUS）一直被认为是治疗非神经性压力性尿失禁（SUI）的金标准。随着新的手术选择试图提供治疗男性 SUI 的替代方法，对支持使用 AUS 的证据进行当代评估似乎对于临床决策是强制性的。
对非神经性 SUI 男性患者接受 AUS 植入后的长期结果进行批判性系统评价。
在 PubMed/Medline 和 Embase 数据库中使用关键词“尿失禁”和“尿道括约肌”、“人工”和“男性”进行文献检索，检索范围限定为 1989 年至 2011 年发表的荷兰语、英语、法语和德语文章。如果报告了非神经性 SUI 患者接受 AUS 植入后的结果且随访时间至少为 2 年，则纳入研究。如果显示了非神经性患者的信息，则将具有异质人群的研究也纳入。
确定了 12 份报告，收集了 623 名患者的数据。只有 3 项研究是前瞻性的。仅通过患者报告的垫使用和各种问卷评估的尿控情况，在 61-100%的病例中实现（无垫或每天用 1 个垫）。无垫的干燥率仅在 7 项研究中可用，范围为 4%-86%。一项汇总分析显示，感染或侵蚀的发生率为 8.5%（3.3-27.8%），机械故障的发生率为 6.2%（2.0-13.8%），尿道萎缩的发生率为 7.9%（1.9-28.6%）。再手术率为 26.0%（14.8-44.8%）。四项研究使用四种不同的工具评估患者满意度，植入 AUS 后似乎有所提高。
根据异质数据、低质量研究和大多数过时的疗效标准，支持非神经性男性 SUI 患者使用 AUS 的证据质量较低。需要重新评估 AUS 的结果，以便与新的手术选择进行比较，所有这些选择都应根据当前的循证医学标准进行前瞻性评估。
