Department of Urology, Tan Tock Seng Hospital, 308433 Singapore.
Advanced Urology, Mount Elizabeth Hospital, 228510 Singapore.
Asian J Androl. 2020 Jan-Feb;22(1):60-63. doi: 10.4103/aja.aja_110_19.
The use of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence has become more prevalent, especially in the "prostate-specific antigen (PSA)-era", when more patients are treated for localized prostate cancer. The first widely accepted device was the AMS 800, but since then, other devices have also entered the market. While efficacy has increased with improvements in technology and technique, and patient satisfaction is high, AUS implantation still has inherent risks and complications of any implant surgery, in addition to the unique challenges of urethral complications that may be associated with the cuff. Furthermore, the unique nature of the AUS, with a control pump, reservoir, balloon cuff, and connecting tubing, means that mechanical complications can also arise from these individual parts. This article aims to present and summarize the current literature on the management of complications of AUS, especially urethral atrophy. We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management. We review the various potential complications and their management. AUS complications are either mechanical or nonmechanical complications. Mechanical complications usually involve malfunction of the AUS. Nonmechanical complications include infection, urethral atrophy, cuff erosion, and stricture. Challenges exist especially in the management of urethral atrophy, with both tandem implants, transcorporal cuffs, and cuff downsizing all postulated as potential remedies. Although complications from AUS implants are not common, knowledge of the management of these issues are crucial to ensure care for patients with these implants. Further studies are needed to further evaluate these techniques.
人工尿失禁括约肌（AUS）在治疗压力性尿失禁中的应用越来越普遍，尤其是在“前列腺特异抗原（PSA）时代”，越来越多的局部前列腺癌患者接受治疗。第一个被广泛接受的设备是 AMS 800，但此后，其他设备也已进入市场。尽管随着技术和技术的改进，疗效有所提高，患者满意度也很高，但 AUS 植入仍然存在任何植入手术固有的风险和并发症，除了与袖口相关的尿道并发症的独特挑战之外。此外，AUS 的独特性质，带有控制泵、储液器、球囊袖口和连接管，意味着这些单独的部件也可能会出现机械并发症。本文旨在介绍和总结目前关于 AUS 并发症（特别是尿道萎缩）管理的文献。我们在 PubMed 上进行了从 1990 年 1 月至 2018 年 12 月的 AUS 并发症及其管理的文献检索。我们回顾了各种潜在的并发症及其管理。AUS 并发症是机械性或非机械性并发症。机械性并发症通常涉及 AUS 故障。非机械性并发症包括感染、尿道萎缩、袖口侵蚀和狭窄。尿道萎缩的管理尤其具有挑战性，有人推测串联植入、经体腔袖口和袖口缩小都是潜在的治疗方法。尽管 AUS 植入物的并发症并不常见，但了解这些问题的管理对于确保这些植入物患者的护理至关重要。需要进一步的研究来进一步评估这些技术。
