Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Department of Urology, Institute for Urologic Excellence, La Quinta, CA, USA.
Int J Impot Res. 2022 Jan;34(1):37-43. doi: 10.1038/s41443-020-0307-8. Epub 2020 May 22.
Although the artificial urinary sphincter (AUS) is widely regarded as the "gold standard" for surgical correction of male stress urinary incontinence, long-term durability for symptom control is variable. A significant number of men will experience a decline in device-related improvement over time. With erosion of initial success, men sufficiently bothered by recurrent incontinence not caused by device malfunction may seek surgical revision. Secondary surgery requires careful consideration on the part of the prosthetic urologist and a keen awareness of sound surgical techniques. The armamentarium for revision has traditionally consisted of strategies involving cuff downsizing and/or relocation, modification of the pressure regulating balloon, urethral wrapping, addition of a tandem cuff, or use of transcorporal cuff placement. These options will be presented in view of their evidence and theoretical advantages and disadvantages. In addition, we will discuss a newer approach of growing popularity that serves to challenge existing dogma and shift the paradigm of AUS revision surgery.
尽管人工尿道括约肌（AUS）被广泛认为是治疗男性压力性尿失禁的“金标准”手术方法，但长期控制症状的效果并不稳定。相当一部分男性会随着时间的推移出现设备相关改善的下降。随着初始成功的消退，那些因设备故障以外的原因而反复出现尿失禁、感到困扰的男性可能会寻求手术修复。二次手术需要假体泌尿科医生的仔细考虑和对健全手术技术的敏锐认识。修复的手段传统上包括缩小和/或重新定位袖套、修改压力调节球囊、尿道包裹、增加串联袖套或使用经体腔袖套放置等策略。鉴于这些方法的证据和理论优缺点，我们将对这些方法进行介绍。此外，我们还将讨论一种较新的、越来越受欢迎的方法，这种方法旨在挑战现有的教条，改变 AUS 修复手术的模式。
