早期行人工尿道括约肌植入术后修正并不会影响长期治疗效果。

Early Revision after Artificial Urinary Sphincter Implantation Does Not Impair the Long-Term Treatment Success.

机构信息

Department of Urology, Menoufia University, Shibin Al Kawm, Egypt.

Department of Urology, Rhein-Maas Hospital, Wuerselen, Germany.

出版信息

Urol Int. 2022;106(3):261-268. doi: 10.1159/000517386. Epub 2021 Jul 21.

DOI:10.1159/000517386

PMID:34289484

Abstract

INTRODUCTION

After implantation of an artificial urinary sphincter (AUS) due to stress urinary incontinence, in some cases revision procedures may be necessary. This is mostly due to device infection or cuff erosion in the long term. The aim of this study was to evaluate the impact of early revision procedures (prior to or immediately after AUS activation) on the long-term outcome.

METHODS

We retrospectively evaluated patients who underwent primary AUS implantation between 2006 and 2019. Patients with previous radiotherapy, urethroplasty, urethral stent placement, or repeat AUS implantation were excluded. Early revision was defined as prior to or immediately after AUS activation and comprised pump repositioning or cuff size adaptation due to difficulties in using the pump, persistent urinary incontinence, or urinary retention. Patients were compared with regard to complication rates, functional outcome, and patient satisfaction. Univariable and multivariable logistic regression analyses were performed to analyze risk factors for early AUS revision. Kaplan-Meier analysis evaluated explantation-free survival.

RESULTS

A total of 250 patients were included. Twenty patients (8%) required early revision (pump repositioning in 15 cases [75%], cuff downsizing in 3 cases [15%], and cuff upsizing in 2 cases [10%]). Mean follow-up was 78.6 months. 96.4% of all patients were objectively continent at the time of last follow-up without differences between both groups, and patient satisfaction was high in both groups. No differences with regard to mechanical implant failure, tissue atrophy, and AUS explantation due to cuff erosion or implant infection were observed. Explantation-free survival was comparable in both groups. On univariable logistic regression analysis, coronary artery disease and transcorporal cuff placement were associated with early AUS revision.

CONCLUSION

Early revision after AUS implantation can be performed without negative impact on the long-term outcome.

摘要

简介

在因压力性尿失禁植入人工尿道括约肌（AUS）后，在某些情况下可能需要进行翻修手术。这主要是由于长期设备感染或袖套侵蚀。本研究旨在评估早期翻修手术（在 AUS 激活之前或之后）对长期结果的影响。

方法

我们回顾性评估了 2006 年至 2019 年期间接受初次 AUS 植入的患者。排除了既往接受过放疗、尿道成形术、尿道支架放置或重复 AUS 植入的患者。早期翻修定义为在 AUS 激活之前或之后进行，包括因使用泵有困难、持续性尿失禁或尿潴留而重新定位泵或适应袖套尺寸。比较了两组患者的并发症发生率、功能结果和患者满意度。进行单变量和多变量逻辑回归分析以分析早期 AUS 翻修的风险因素。Kaplan-Meier 分析评估了免于器械移除的生存率。

结果

共纳入 250 例患者。20 例（8%）需要早期翻修（15 例[75%]为泵重新定位，3 例[15%]为袖套缩小，2 例[10%]为袖套增大）。平均随访时间为 78.6 个月。所有患者在最后一次随访时 96.4%均客观上无尿失禁，两组间无差异，且两组患者满意度均较高。两组间在机械植入物失效、组织萎缩以及因袖套侵蚀或植入物感染导致的 AUS 移除方面无差异。两组免于器械移除的生存率相当。单变量逻辑回归分析显示，冠状动脉疾病和经 corporal 袖套放置与早期 AUS 翻修相关。