Cordon Billy H, Singla Nirmish, Singla Ajay K
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Urology, University of Toledo College of Medicine, Toledo, OH, USA.
Med Devices (Auckl). 2016 Jul 4;9:175-83. doi: 10.2147/MDER.S93637. eCollection 2016.
The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.
人工尿道括约肌（AUS）历经多年发展，已成为治疗压力性尿失禁的一种安全可靠的方法，目前是金标准。在存在了40年之后，人们对AUS有了丰富的经验。如今，AUS最常用于前列腺切除术后压力性尿失禁。只有一小部分泌尿科医生常规植入AUS。在2005年的一项调查中，只有4%的泌尿科医生被认为是大量植入AUS的医生，即每年植入超过20例。在全球范围内，每年植入约11,500个AUS。关于AUS治疗结果已发表了400多篇文章，成功率差异很大，从61%到100%不等。一般来说，AUS有良好的长期效果，社交控尿率约为79%，患者满意度通常在80%至90%之间。尽管效果良好，但相当一部分患者，通常约25%，将需要进行翻修手术，且翻修率会随着时间增加。需要翻修的并发症包括感染、尿道萎缩、侵蚀和机械故障。大多数感染是革兰氏阳性皮肤菌群。尿道萎缩和侵蚀是由同一个问题——持续的尿道压迫导致的一系列情况。然而，这两种并发症的处理方式不同。机械故障通常是一种晚期并发症，平均发生时间晚于感染、萎缩或侵蚀。翻修时可采用各种技术，包括袖带重新定位、缩小尺寸、经体部袖带放置或串联袖带放置。只要恢复了控尿功能，患者满意度似乎不会受到翻修需求的影响。此外，先前吊带手术后植入AUS的结果与初次植入AUS相当。有几项新发明即将问世，不过目前在美国均未获批使用。
