Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2014 Apr;191(4):1104-8. doi: 10.1016/j.juro.2013.09.032. Epub 2013 Sep 20.
We review our experience with artificial urinary sphincter and augmentation cystoplasty in patients with neurogenic bladder. This is the largest known series to specifically evaluate cuff only artificial urinary sphincter at augmentation cystoplasty.
A total of 18 males underwent simultaneous artificial urinary sphincter and augmentation cystoplasty at our institution between 1982 and 2012, of whom 13 (72%) underwent cuff only artificial urinary sphincter. Outcomes included urinary continence, emptying modality, artificial urinary sphincter status, complications and additional procedures.
Of the patients undergoing augmentation cystoplasty and cuff only artificial urinary sphincter 10 (77%) were initially continent. Average time of continence was 52.9 months. Four patients (31%) required no additional procedures and remained continent. Urinary incontinence developed in 3 patients (23%) immediately postoperatively and in 6 (46%) subsequently. Ultimately 9 patients (69%) required conversion to complete artificial urinary sphincter at a mean of 36.9 months postoperatively. Overall 12 patients (92%) were continent at followup. There were no artificial sphincter specific complications in patients undergoing the cuff only procedure with conversion to complete artificial urinary sphincter. After conversion to complete artificial urinary sphincter 3 patients (23%) experienced artificial sphincter specific complications. Reoperation was performed in 10 patients (77%), for 13 total procedures (1.3 per patient). There were no complications with cuff only artificial urinary sphincter and 6 complications with complete artificial urinary sphincter (p = 0.025). Finally, patients undergoing cuff only artificial urinary sphincter requiring revision were younger than those not requiring revision (15.6 vs 30.8 years, p = 0.026).
Simultaneous cuff only artificial urinary sphincter and augmentation cystoplasty appears safe and efficacious in patients with neurogenic bladder, with fewer complications than complete artificial urinary sphincter, and may provide definitive urinary continence in up to a third of patients. This procedure is technically easy, allows for outpatient revision, provides time for the child to mature and may be cost effective in avoiding placement of additional components in this select patient population.
我们回顾了神经源性膀胱患者中人工尿道括约肌和膀胱扩大术的经验。这是已知的最大系列专门评估在膀胱扩大术中仅使用袖套的人工尿道括约肌。
1982 年至 2012 年期间，我院共有 18 名男性患者同时接受人工尿道括约肌和膀胱扩大术，其中 13 名（72%）仅接受袖套式人工尿道括约肌。结果包括尿控、排空方式、人工尿道括约肌状态、并发症和其他手术。
在接受膀胱扩大术和仅使用袖套的人工尿道括约肌的患者中，有 10 名（77%）最初是尿控的。平均尿控时间为 52.9 个月。4 名（31%）患者无需进一步手术且仍保持尿控。3 名（23%）患者术后即刻发生尿失禁，6 名（46%）患者随后发生尿失禁。最终，9 名（69%）患者在术后平均 36.9 个月时需要转换为完全人工尿道括约肌。总体而言，12 名（92%）患者在随访时仍保持尿控。在仅使用袖套的患者中，无人工括约肌相关并发症，而在转换为完全人工尿道括约肌后，有 12 名（92%）患者发生了 13 次（1.3 次/人）人工括约肌相关并发症。10 名（77%）患者进行了再次手术，共进行了 13 次手术（每例患者 1.3 次）。仅使用袖套的人工尿道括约肌无并发症，而完全人工尿道括约肌有 6 例（p = 0.025）并发症。最后，需要进行修订的仅使用袖套的人工尿道括约肌患者比无需修订的患者年轻（15.6 岁 vs 30.8 岁，p = 0.026）。
对于神经源性膀胱患者，同时进行袖套式人工尿道括约肌和膀胱扩大术是安全有效的，与完全人工尿道括约肌相比，并发症更少，并且可能为多达三分之一的患者提供明确的尿控。该手术技术简单，可进行门诊修正，为儿童成熟提供时间，并且在选择的患者群体中可能具有成本效益，避免了额外组件的放置。
