Manfredi Celeste, Krishnappa Pramod, Fernández-Pascual Esaú, García Criado Elena, Rengifo Diego, Vázquez Alba David, Carballido Joaquín, Arcaniolo Davide, Martínez-Salamanca Juan Ignacio
Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Andrology Division, Department of Urology, NU Hospitals, Bangalore, India.
Int Neurourol J. 2022 Jun;26(2):161-168. doi: 10.5213/inj.2142122.061. Epub 2022 Mar 8.
To evaluate the preoperative and intraoperative risk factors for revision after artificial urinary sphincter (AUS) implantation in male patients with stress urinary incontinence (SUI).
A retrospective analysis from a prospectively maintained database was performed. Male patients, with moderate-tosevere SUI, undergoing AUS implantation were included. All patients underwent placement of AMS 800. Cause of revision, type of revision, and time to revision were recorded. Multivariable analyzes were performed using a logistic regression to investigate the risk factors. Competing risk analysis according to Fine-Gray model was used to study time to event data.
A total of 70 patients were included. Revision surgery was performed in 22 of 70 patients (31.4%), after a median (interquartile range) time of 26.5 months (6.5-39.3 months). Overall, 19 of 22 repairs (86.4%) and 3 of 22 explants (13.6%) were recorded. Mechanical dysfunction, urethral erosion, urethral atrophy, and device infection were the causes of revision in 11 of 22 (50.0%), 6 of 22 (27.3%), 3 of 22 (13.6%), and 2 of 22 patients (9.1%). Vesicourethral anastomosis stenosis (P=0.02), urethral cuff size of 3.5 cm (P=0.029), and dual implantation (P=0.048) were independent predictors for revision. Vesicourethral anastomosis stenosis (P=0.01) and urethral cuff size of 3.5 cm (P=0.029) predicted a lower survival of the AUS.
The vesicourethral anastomosis stenosis, urethral cuff size of 3.5 cm, and dual implantation are independent predictors for revision after AUS implantation. However, only the vesicourethral anastomosis stenosis and urethral cuff size of 3.5 cm predict a lower survival of AUS.
评估男性压力性尿失禁（SUI）患者人工尿道括约肌（AUS）植入术后翻修的术前和术中危险因素。
对前瞻性维护的数据库进行回顾性分析。纳入接受AUS植入术的中重度SUI男性患者。所有患者均植入AMS 800。记录翻修原因、翻修类型和翻修时间。采用逻辑回归进行多变量分析以研究危险因素。根据Fine-Gray模型进行竞争风险分析以研究事件发生时间数据。
共纳入70例患者。70例患者中有22例（31.4%）接受了翻修手术，中位（四分位间距）时间为26.5个月（6.5 - 39.3个月）。总体而言，记录了22例翻修中的19例修复（86.4%）和22例取出中的3例（13.6%）。机械功能障碍、尿道侵蚀、尿道萎缩和装置感染分别是22例患者中11例（50.0%）、6例（27.3%）、3例（13.6%）和2例（9.1%）翻修的原因。膀胱尿道吻合口狭窄（P = 0.02）、尿道袖带尺寸为3.5 cm（P = 0.029）和双重植入（P = 0.048）是翻修的独立预测因素。膀胱尿道吻合口狭窄（P = 0.01）和尿道袖带尺寸为3.5 cm（P = 0.029）预示AUS的较低生存率。
膀胱尿道吻合口狭窄、尿道袖带尺寸为3.5 cm和双重植入是AUS植入术后翻修的独立预测因素。然而，只有膀胱尿道吻合口狭窄和尿道袖带尺寸为3.5 cm预示AUS的较低生存率。
