Kretschmer Alexander, Hüsch Tanja, Thomsen Frauke, Kronlachner Dominik, Obaje Alice, Anding Ralf, Pottek Tobias, Rose Achim, Olianas Roberto, Friedl Alexander, Hübner Wilhelm, Homberg Roland, Pfitzenmaier Jesco, Queissert Fabian, Naumann Carsten M, Wotzka Carola, Hofmann Torben, Seiler Roland, Haferkamp Axel, Bauer Ricarda M
Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany.
Department of Urology, University Medical Center of Johannes-Gutenberg University, Mainz, Germany.
Int Neurourol J. 2017 Jun;21(2):109-115. doi: 10.5213/inj.1632626.313. Epub 2017 Jun 21.
To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort.
Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05).
We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001).
Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.
在一个大型、当代、多机构的患者队列中，分析选定的可调节男性吊带系统和会阴单袖口人工尿道括约肌（AUS）的围手术期并发症和术后取出率。
纳入2010年至2012年在13个参与机构接受植入手术的282例男性患者（n = 127例可调节男性吊带 [n = 95例阿格斯经典款，n = 32例阿格斯T型]，n = 155例AUS）。分析围手术期特征和术后并发症。使用Fisher精确检验和Mann-Whitney U检验评估各装置的取出率。生成Kaplan-Meier曲线。使用多元逻辑回归模型分析与装置取出相关的潜在特征（P<0.05）。
我们发现可调节男性吊带植入术后术中并发症发生率显著增加（15.9% [可调节男性吊带] 对4.2% [AUS]，P = 0.003）。最常见的术中并发症是膀胱穿孔（n = 17）。各装置术后感染率无显著差异（P = 0.378）。AUS植入术后装置取出率显著更高（9.7% [可调节男性吊带] 对21.5% [AUS]，P = 0.030）。在多变量分析中，术后感染是装置生存率降低的强有力独立预测因素（比值比，6.556；P = 0.001）。
可调节男性吊带和AUS的并发症情况不同。可调节男性吊带植入术后取出率较低。任何类型的术后感染都是装置生存率降低的独立预测因素。植入机构的经验对装置生存率没有显著影响。
