Loh-Doyle Jeffrey C, Ashrafi Akbar, Nazemi Azadeh, Ghodoussipour Saum, Thompson Eli, Wayne Kevin, Boyd Stuart D
USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Urology. 2019 May;127:127-132. doi: 10.1016/j.urology.2019.01.010. Epub 2019 Jan 18.
To determine the impact of radical cystectomy and orthotopic neobladder (NB) diversion on device-related outcomes in patients who undergo subsequent placement of both, an artificial urinary sphincter (AUS) and 3-piece inflatable penile prosthesis.
Using an institutional prosthetic database, we identified 39 patients who underwent radical cystectomy and NB and subsequent implantation of both prosthetic devices from 2003 to 2017. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection, mechanical failure, revision surgery, and functional outcomes were examined and compared to an appropriate matched group of patients (n = 48, non-neobladder group).
No intraoperative complications were observed. After median follow-up of 94 months (12-177 months), 1 patient developed an infection of their penile prosthesis and 4 patients developed an erosion of their AUS. In each case, the infection did not involve the other device. Two patients required revision surgery of their penile prosthesis due to mechanical failure (reservoir leak, n = 1; cylinder aneurysm, n = 1). Twenty-one patients underwent elective revision surgery to improve continence (cuff downsizing, n = 18; pressure-regulating balloon exchange, n = 3). There were 6 cases of AUS mechanical failure. No reservoir-related complications such as herniation or erosion were observed. Compared to the control group of non-neobladder patients, there were no significant differences in prosthetic infection, mechanical failure, and revision surgery.
The AUS and 3-piece inflatable penile prosthesis can coexist safely in patients with NB without an increased risk of device-related complications.
确定根治性膀胱切除术和原位新膀胱（NB）改道对随后接受人工尿道括约肌（AUS）和三件式可膨胀阴茎假体植入的患者器械相关结局的影响。
利用机构假体数据库，我们确定了39例在2003年至2017年间接受根治性膀胱切除术和NB以及随后两种假体植入的患者。检查患者人口统计学、围手术期数据和术后结局，包括假体感染、机械故障、翻修手术和功能结局，并与适当匹配的患者组（n = 48，非新膀胱组）进行比较。
未观察到术中并发症。中位随访94个月（12 - 177个月）后，1例患者发生阴茎假体感染，4例患者发生AUS侵蚀。在每种情况下，感染均未累及另一器械。2例患者因机械故障（储液器泄漏，n = 1；圆柱体动脉瘤，n = 1）需要对阴茎假体进行翻修手术。21例患者接受了选择性翻修手术以改善控尿（袖带缩小，n = 18；压力调节球囊更换，n = 3）。有6例AUS机械故障。未观察到与储液器相关的并发症，如疝或侵蚀。与非新膀胱患者的对照组相比，在假体感染、机械故障和翻修手术方面无显著差异。
AUS和三件式可膨胀阴茎假体可在NB患者中安全共存，且器械相关并发症风险未增加。
