Moses Rachel A, Keihani Sorena, Craig James R, Basilius Jacob, Hotaling James M, Lenherr Sara M, Brant William O, Myers Jeremy B
Center for Reconstructive Urology, University of Utah, Salt Lake City, UT.
Center for Reconstructive Urology, University of Utah, Salt Lake City, UT.
Urology. 2019 Jan;123:252-257. doi: 10.1016/j.urology.2018.07.052. Epub 2018 Sep 7.
To assess the efficacy of exchanging the pressure regulating balloon (PRB) to 71-80 cm HO in patients with persistent or recurrent stress urinary incontinence (SUI) following artificial urinary sphincter (AUS) placement.
Patients with SUI following AUS placement who underwent PRB replacement between 2011 and 2017 in the absence of urethral cuff malfunction, atrophy, stricture, or erosion were reviewed. Primary outcomes included changes in pad per day (PPD), Incontinence Symptom Index score, and Incontinence Quality of Life (I-QOL). Secondary outcomes included rates of device erosion and all-cause explant or revision. Differences were compared between patients with and without erosion, explant, or revision. Kaplan Meier device survival analysis was performed.
Twenty two patients (67 ± 9 years, body mass index of 30 ± 5 kg/m) with a median follow up of 22.4 months (IQR 9.3, 47.3) were included. Incontinence etiology included radical prostatectomy in 60% of patients. After PRB exchange, the average number of PPD decreased from 4.0 ± 3.0 to 1.0 ± 1.6 PPD (P = .01), as did Incontinence Symptom Index scores (21.6 ± 8.5 vs 16.3 ± 8.1, P <.001) and Incontinence Quality of Life (15.2 ± 6.8 vs 7.2 ± 3.4, P = .01). Three patients with prior radiation (14%) experienced cuff erosion. The explantation/revision rate was 45%(10/22) at 33.5(IQR 8.9,48) months. Kaplan-Meier analysis demonstrated 68%(15/22) and 41%(9/22) retained their device for 12 and 24 months, respectively.
PRB exchange can transiently alleviate persistent or recurrent post-AUS SUI in the absence of mechanical failure or urethral pathology. Caution is warranted in patients with prior radiation as this was a risk factor for urethral erosion. Although many patients may require device revision within 2 years, it can be a temporizing solution that avoids urethral manipulation and periprocedural device deactivation.
评估在人工尿道括约肌（AUS）置入后出现持续性或复发性压力性尿失禁（SUI）的患者中，将压力调节球囊（PRB）压力调整至71 - 80 cm H₂O的疗效。
回顾2011年至2017年间接受PRB置换且不存在尿道袖带故障、萎缩、狭窄或糜烂的AUS置入术后SUI患者。主要结局包括每日尿垫使用量（PPD）的变化、尿失禁症状指数评分及尿失禁生活质量（I - QOL）。次要结局包括装置糜烂率以及全因取出或翻修率。比较有或没有糜烂、取出或翻修的患者之间的差异。进行Kaplan - Meier装置生存分析。
纳入22例患者（年龄67±9岁，体重指数30±5 kg/m²），中位随访时间为22.4个月（四分位间距9.3，47.3）。尿失禁病因包括60%的患者为根治性前列腺切除术。PRB置换后，平均PPD从4.0±3.0降至1.0±1.6（P = 0.01），尿失禁症状指数评分也下降（21.6±8.5对16.3±8.1，P < 0.001），尿失禁生活质量评分同样下降（15.2±6.8对7.2±3.4，P = 0.01）。3例曾接受放疗的患者（14%）出现袖带糜烂。在33.5个月（四分位间距8.9，48）时，取出/翻修率为45%（10/22）。Kaplan - Meier分析显示，分别有68%（15/22）和41%（9/22）的患者在12个月和24个月时仍保留其装置。
在不存在机械故障或尿道病变的情况下，PRB置换可暂时缓解AUS置入术后持续性或复发性SUI。对于曾接受放疗的患者需谨慎，因为这是尿道糜烂的一个危险因素。尽管许多患者可能在2年内需要装置翻修，但这可以是一种避免尿道操作和围手术期装置停用的临时解决方案。
