Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
Urology. 2023 Aug;178:155-161. doi: 10.1016/j.urology.2023.02.050. Epub 2023 Apr 25.
To treat men with bladder neck contracture (BNC) and stress urinary incontinence, neither long-term nor comparative data exist to support the superiority of simultaneous BNC intervention at the time of artificial urinary sphincter placement (synchronous) or staged BNC intervention followed by artificial urinary sphincter placement (asynchronous). This study aimed to compare the outcomes of patients treated with synchronous and asynchronous protocols.
Using a prospectively maintained quality improvement database, we identified all men between the years of 2001-2021 with a history of BNC and artificial urinary sphincter placement. Baseline patient characteristics and outcome measures were collected. Categorical data were assessed with Pearson's Chi-square, and continuous data were assessed using independent sample t tests or the Wilcoxon Rank-Sum test.
In total, 112 men met the inclusion criteria. Thirty-two patients were treated synchronously, and 80 were treated asynchronously. There were no significant differences between groups across 15 relevant variables. Overall follow-up duration was 7.1 (2.8, 13.1) years. Three (9.3%) in the synchronous group and 13 (16.2%) in the asynchronous group experienced an erosion. There were no significant differences in frequency of erosion, time to erosion, artificial sphincter revision, time to revision, or BNC recurrence. BNC recurrences after artificial sphincter placement were treated with serial dilation with no early device failure or erosion.
Similar outcomes are achieved following synchronous and asynchronous treatment of BNC and stress urinary incontinence. Synchronous approaches should be considered safe and effective for men with stress urinary incontinence and BNC.
治疗患有膀胱颈挛缩（BNC）和压力性尿失禁的男性，目前尚无长期或对比数据支持在人工尿道括约肌置入时同时进行 BNC 干预（同步）或分期 BNC 干预后再进行人工尿道括约肌置入（异步）的优越性。本研究旨在比较采用同步和异步方案治疗的患者的结局。
我们使用前瞻性维护的质量改进数据库，确定了 2001 年至 2021 年间患有 BNC 和人工尿道括约肌置入史的所有男性。收集了基线患者特征和结局测量值。采用 Pearson 卡方检验评估分类数据，采用独立样本 t 检验或 Wilcoxon 秩和检验评估连续数据。
共有 112 名男性符合纳入标准。32 名患者接受同步治疗，80 名患者接受异步治疗。15 个相关变量在两组之间无显著差异。总体随访时间为 7.1（2.8，13.1）年。同步组有 3 例（9.3%）和异步组有 13 例（16.2%）发生了侵蚀。侵蚀的频率、侵蚀时间、人工括约肌翻修、翻修时间或 BNC 复发无显著差异。人工括约肌置入后发生 BNC 复发采用了连续扩张治疗，没有早期器械失效或侵蚀。
同步和异步治疗 BNC 和压力性尿失禁的结局相似。对于患有压力性尿失禁和 BNC 的男性，同步方法应被认为是安全有效的。
