Léon Priscilla, Chartier-Kastler Emmanuel, Rouprêt Morgan, Ambrogi Vanina, Mozer Pierre, Phé Véronique
Department of Urology, Pitié-Salpétrière Academic Hospital, Paris, France.
Department of Statistics, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France.
BJU Int. 2015 Jun;115(6):951-7. doi: 10.1111/bju.12848. Epub 2014 Oct 23.
To evaluate long-term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery.
Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow-up. Kaplan-Meier survival curves estimated the survival rate of the device without needing explantation or revision.
In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64-72) years. The median (IQR) duration of follow-up was 15 (8.25-19.75) years. At the end of follow-up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow-up, in intention-to-treat analysis, 77.2% of patients were continent.
In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
评估人工尿道括约肌（AUS）的长期功能结局，并确定因前列腺手术后括约肌功能不全导致压力性尿失禁（SUI）而需要取出植入物的男性患者数量。
纳入1984年至1992年间因前列腺手术后括约肌功能不全导致SUI而接受AUS（美国美敦力公司AMS 800®）植入的男性患者。随访结束时评估尿失禁情况，定义为无需使用尿垫。采用Kaplan-Meier生存曲线估计无需取出或翻修装置的生存率。
共纳入57例连续患者，中位（四分位间距，IQR）年龄为69（64 - 72）岁。中位（IQR）随访时间为15（8.25 - 19.75）年。随访结束时，25例患者（43.8%）仍保留其初次植入的AUS。9例男性因侵蚀（7例）和感染（2例）取出了AUS。在5年、10年、15年和20年时，未取出AUS的生存率分别为87%、87%、80%和80%。在5年、10年、15年和20年时，未进行AUS翻修的生存率分别为59%、28%、15%和5%。随访结束时，在意向性分析中，77.2%的患者实现了控尿。
从长期（>10年）来看，AMS 800可为因括约肌功能不全导致SUI的男性患者提供较高的控尿率，且取出和翻修率可接受。
