Ziegelmann Matthew J, Linder Brian J, Viers Boyd R, Rangel Laureano J, Rivera Marcelino E, Elliott Daniel S
Department of Urology, Mayo Clinic, Rochester, MN, United States.
Turk J Urol. 2018 Nov 26;45(2):124-128. doi: 10.5152/tud.2018.82781. Print 2019 Mar.
Artificial urinary sphincter (AUS) device failure or revision can be due to multiple etiologies including erosion, infection, mechanical malfunction, and urethral atrophy. However, few studies have evaluated factors that predispose patients to urethral atrophy. Here, we sought to identify preoperative and perioperative risk factors associated with urethral atrophy in men undergoing primary artificial urinary sphincter (AUS) placement for stress urinary incontinence.
From 1987 to 2013, 1829 AUS procedures were performed at our institution. A total of 1068 patients underwent primary AUS placement and were the focus of our study. Multiple clinical and surgical variables were evaluated for a potential association with revision for atrophy. Those found to be associated with atrophy and relevant competing risks were further evaluated on multivariable analysis.
With a median follow-up of 4.2 years (IQR 1.3-8.1), 89 men (8.3%) had urethral atrophy requiring reoperation. Median time to revision was 4.5 years (IQR 1.9-7.6). On univariable analysis, only smaller cuff size (4.0-cm versus 4.5-cm; HR 3.1, p=0.04) was associated with an increased rate of urethral atrophy. Notably, patient age at the time of surgery (p=0.62), body mass index (0.22), and smoking status (p=1.00) were not associated with a risk of atrophy. On multivariable analysis smaller urethral cuff size remained significant (HR 2.8, 95% CI 1.1-7.1; p=0.01).
Revision surgery for urethral atrophy was performed in approximately 8% of men undergoing primary AUS placement. Utilization of a smaller AUS cuff size appears to be an independent factor associated with increased rate of urethral atrophy.
人工尿道括约肌（AUS）装置故障或翻修可能由多种病因引起，包括侵蚀、感染、机械故障和尿道萎缩。然而，很少有研究评估使患者易患尿道萎缩的因素。在此，我们试图确定在因压力性尿失禁接受初次人工尿道括约肌（AUS）植入术的男性中，与尿道萎缩相关的术前和围手术期风险因素。
1987年至2013年，我们机构共进行了1829例AUS手术。共有1068例患者接受了初次AUS植入术，他们是我们研究的重点。评估了多个临床和手术变量与因萎缩而进行翻修的潜在关联。那些与萎缩及相关竞争风险相关的因素在多变量分析中进一步评估。
中位随访时间为4.2年（四分位间距1.3 - 8.1年），89名男性（8.3%）出现尿道萎缩需要再次手术。翻修的中位时间为4.5年（四分位间距1.9 - 7.6年）。单变量分析显示，只有较小的袖带尺寸（4.0厘米对4.5厘米；风险比3.1，p = 0.04）与尿道萎缩发生率增加相关。值得注意的是，手术时患者年龄（p = 0.62）、体重指数（0.22）和吸烟状况（p = 1.00）与萎缩风险无关。多变量分析显示，较小的尿道袖带尺寸仍然具有显著意义（风险比2.8，95%置信区间1.1 - 7.1；p = 0.01）。
在接受初次AUS植入术的男性中，约8%进行了因尿道萎缩的翻修手术。使用较小尺寸的AUS袖带似乎是与尿道萎缩发生率增加相关的独立因素。
