Division of Urology and University of Toronto Research Program in Functional Urology, University of Toronto, Toronto, Ontario, Canada.
Division of Urology and University of Toronto Research Program in Functional Urology, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2018 Nov;200(5):1093-1098. doi: 10.1016/j.juro.2018.05.143. Epub 2018 Jun 22.
The artificial urinary sphincter is a common treatment of male urinary incontinence. We sought to characterize long-term rates of artificial urinary sphincter revision/removal and reimplantation, and associated risk factors.
We performed a population based, retrospective study using the Ontario Health Insurance Plan database of all male patients who underwent artificial urinary sphincter implantation from 1994 to 2013. Hospital, diagnostic and billing codes were used to identify patients. The Kaplan-Meier method and multivariable Cox proportional hazards models were applied to examine the cumulative incidence of artificial urinary sphincter reimplantation and revision/removal, and identify risk factors, respectively.
A total of 1,632 male patients underwent initial implantation of an artificial urinary sphincter. The 10-year revision/removal and reimplantation rates were 34% and 27%, respectively. There was no difference between high and low volume hospitals or between community and academic hospitals in terms of revision/removal. A high level of comorbidity was associated with an increasing risk of removal/revision. The reimplantation rate was significantly lower in patients who underwent insertion at hospitals with the highest volume of surgery (HR 0.55, 95% CI 0.37-0.82, p <0.01). A high level of comorbidity was not associated with an increasing risk of reimplantation. Preimplantation radiotherapy was not significantly associated with the risk of reimplantation (p = 0.17) or revision/removal (p = 0.95). Other factors were not significantly associated with reimplantation or revision/removal.
Most men who undergo artificial urinary sphincter placement still have a device without repeat surgery 10 years following insertion. Radiotherapy does not increase the risk of repeat surgery. A high level of comorbidity was associated with an increasing risk of removal/revision.
人工尿道括约肌是治疗男性尿失禁的常用方法。我们旨在描述人工尿道括约肌翻修/移除和再植入的长期比率，以及相关的风险因素。
我们使用 1994 年至 2013 年期间所有接受人工尿道括约肌植入术的男性患者的安大略省医疗保险计划数据库进行了一项基于人群的回顾性研究。使用医院、诊断和计费代码来识别患者。应用 Kaplan-Meier 方法和多变量 Cox 比例风险模型分别检查人工尿道括约肌再植入和翻修/移除的累积发生率，并确定风险因素。
共有 1632 名男性患者接受了初始人工尿道括约肌植入术。10 年的翻修/移除和再植入率分别为 34%和 27%。在翻修/移除方面，高容量医院和低容量医院之间或社区医院和学术医院之间没有差异。高合并症水平与移除/翻修的风险增加相关。在手术量最高的医院接受插入的患者，再植入率显著降低（HR 0.55，95%CI 0.37-0.82，p<0.01）。高合并症水平与再植入的风险增加无关。术前放疗与再植入的风险（p=0.17）或翻修/移除的风险（p=0.95）均无显著相关性。其他因素与再植入或翻修/移除均无显著相关性。
大多数接受人工尿道括约肌植入术的男性在植入后 10 年仍无需再次手术。放疗并不会增加再次手术的风险。高合并症水平与移除/翻修的风险增加相关。
