Department of Urology, Menoufia University, Shebeen El Kom, Egypt.
Department of Urology, Rhein-Maas Hospital, Würselen, Germany.
World J Urol. 2020 Jan;38(1):183-191. doi: 10.1007/s00345-019-02756-0. Epub 2019 Apr 12.
To evaluate the impact of previous urethroplasty on complication rates and postoperative continence after primary artificial urinary sphincter (AUS) implantation in male patients with severe stress urinary incontinence.
A prospective evaluation of patients undergoing primary AUS implantation was conducted. Patients with previous radiotherapy, AUS implantation or urethral stent placement were excluded. Main endpoints were postoperative continence and complication rates including necessity of AUS explantation. Kaplan-Meier analysis evaluated explantation-free survival. Logistic regression analyses were performed to identify potential predictors for AUS explantation.
105 patients were included with a mean follow-up of 76.6 months (SD 15.9). 30 of these patients had a history of urethroplasty. Postoperatively, 96.2% of all patients were objectively continent (≤ 1 pad/day). No differences in postoperative continence and early complication rates were observed. Concerning long-term complications, infection, mechanical implant failure, and tissue atrophy were also comparable. Overall sphincter erosion rate was 12.3%, but significantly higher in urethroplasty patients (23.3% vs. 8.0%, p = 0.038) and sphincter explantation rate was threefold higher (p = 0.016) in the urethroplasty group. Furthermore, explantation-free survival was reduced compared to the non-urethroplasty group (p = 0.044). On logistic regression analysis, the previous urethroplasty was the only significant predictor for AUS explantation (p = 0.016).
AUS implantation in patients with former urethroplasty can provide satisfying results. Compared to patients without the previous urethroplasty, the higher risk of cuff erosion and AUS explantation has to be addressed during preoperative consultation. Patients with the previous urethroplasty with grafting, long strictures and previous visual internal urethrotomy might be at highest risk.
评估既往尿道成形术对严重压力性尿失禁男性患者初次行人工尿道括约肌（AUS）植入术后并发症发生率和术后控尿的影响。
对行初次 AUS 植入术的患者进行前瞻性评估。排除既往接受过放疗、AUS 植入或尿道支架置入的患者。主要终点为术后控尿率和并发症发生率，包括 AUS 取出的必要性。采用 Kaplan-Meier 分析评估无 AUS 取出的生存率。采用逻辑回归分析确定 AUS 取出的潜在预测因素。
共纳入 105 例患者，平均随访 76.6 个月（标准差 15.9）。其中 30 例患者有尿道成形术病史。所有患者术后客观控尿率为 96.2%（≤ 1 片/天）。术后控尿率和早期并发症发生率无差异。长期并发症方面，感染、机械植入物失败和组织萎缩也相似。总体括约肌侵蚀率为 12.3%，但在尿道成形术患者中明显更高（23.3%比 8.0%，p=0.038），且在尿道成形术组中，AUS 取出率高 3 倍（p=0.016）。此外，与非尿道成形术组相比，无 AUS 取出的生存率降低（p=0.044）。逻辑回归分析显示，既往尿道成形术是 AUS 取出的唯一显著预测因素（p=0.016）。
对于有既往尿道成形术的患者，AUS 植入术可以提供满意的结果。与无既往尿道成形术的患者相比，在术前咨询时必须注意袖套侵蚀和 AUS 取出的风险更高。既往有移植物尿道成形术、长段狭窄和既往可视尿道内切开术的患者风险最高。
