Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Urol. 2023 May 20;23(1):97. doi: 10.1186/s12894-023-01274-x.
Urinary incontinence (UI) is a common worldwide rising health issue among women with a prevalence of 5 to 70%. Stress urinary incontinence (SUI) is the most common subtype of UI. There are different treatments for UI, including AUS (artificial urinary sphincter) implantation, as one of the surgical options for treating SUI. The aim of this study was to determine the complication rate of AUS, exclusively in female patients with SUI, which resulted from ISD (intrinsic sphincter deficiency). We also compared the complication rate between minimally invasive (laparoscopic or robotic surgery) and open approaches.
Scopus, PubMed, Web of Science, Embase, and Google Scholar were searched for studies regarding complications in AUS implantation surgery, from the beginning of the project to March 2022. After screening and reviewing of full text, the general characteristics of the study and study population including follow-up time, type of surgery, and the number of complications that occurred such as necrosis, atrophy, erosion, infection, mechanical failure, revision, and leak, were extracted.
We found that atrophy occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 1 of 669 (0.15%) patients treated with open surgery. None of the 17 included studies reported the occurrence of necrosis in the patients under study. Erosion occurred in 9 of 188 (4.78%) patients treated with minimally invasive surgery and in 41 of 669 (6.12%) patients treated with open surgery. Infection occurred in 12 of 188 (6.38%) patients treated with minimally invasive surgery and in 22 of 669 (3.2%) patients treated with open surgery. The mechanical failure occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 55 of 669 (8.22%) patients treated with open surgery. Reconstructive surgery occurred in 7 of 188 (3.72%) patients treated with minimally invasive surgery and in 95 of 669 (14.2%) patients treated with open surgery. Leaks occurred in 4 of 188 (2.12%) patients treated with minimally invasive surgery and in 6 of 669 (0.89%) patients treated with open surgery. The type of surgery was associated with a statistically significant increase in mechanical failure (p-value = 0.067) and infection (p-value = 0.021), and reconstructive surgery (p-value = 0.049). Out of the 857 participats in the study,469 were studied for less than five years and 388 were studied for more than five years.21 of 469 (4.4%) (p-value = 0.08) patients and 81 of 388 (20.8%) (p-value = 0.001) patients required reconstructive surgery. Erosion occurred in 23 of 469 (4.9%) (p-value = 0.01)patients with following time less than five years and in 27 of 388 (6.9%) (p-value = 0.001) patients with following time more than five years.
The use of artificial urinary sphincters in the treatment of UI causes complications such as atrophy, erosion, and infection; the amount of which is influenced by the surgical method and the duration of using the artificial urinary sphincter. It seems that the use of new surgical methods, such as laparoscopic surgery, is useful in reducing the incidence of complications.
尿失禁（UI）是全球女性普遍存在的一个日益严重的健康问题，其患病率为 5%至 70%。压力性尿失禁（SUI）是最常见的 UI 亚型。UI 有不同的治疗方法，包括人工尿道括约肌（AUS）植入术，作为治疗 SUI 的一种手术选择。本研究旨在确定 AUS 在因固有括约肌缺陷（ISD）导致 SUI 的女性患者中的并发症发生率。我们还比较了微创（腹腔镜或机器人手术）和开放方法的并发症发生率。
从项目开始到 2022 年 3 月，我们在 Scopus、PubMed、Web of Science、Embase 和 Google Scholar 上搜索了关于 AUS 植入手术并发症的研究。经过筛选和全文回顾，提取了研究的一般特征和研究人群，包括随访时间、手术类型以及发生的并发症数量，如坏死、萎缩、侵蚀、感染、机械故障、修复和漏尿。
我们发现微创治疗的 188 例患者中有 1 例（0.53%）发生萎缩，开放治疗的 669 例患者中有 1 例（0.15%）发生萎缩。17 项纳入研究均未报告研究患者发生坏死。微创治疗的 188 例患者中有 9 例（4.78%）发生侵蚀，开放治疗的 669 例患者中有 41 例（6.12%）发生侵蚀。微创治疗的 188 例患者中有 12 例（6.38%）发生感染，开放治疗的 669 例患者中有 22 例（3.2%）发生感染。微创治疗的 188 例患者中有 1 例（0.53%）发生机械故障，开放治疗的 669 例患者中有 55 例（8.22%）发生机械故障。微创治疗的 188 例患者中有 7 例（3.72%）需要重建手术，开放治疗的 669 例患者中有 95 例（14.2%）需要重建手术。微创治疗的 188 例患者中有 4 例（2.12%）发生漏尿，开放治疗的 669 例患者中有 6 例（0.89%）发生漏尿。手术类型与机械故障（p 值=0.067）和感染（p 值=0.021）以及重建手术（p 值=0.049）的发生率显著相关。在 857 名研究参与者中，469 名患者的随访时间不足 5 年，388 名患者的随访时间超过 5 年。469 名患者中有 21 名（4.4%）（p 值=0.08）和 388 名患者中有 81 名（20.8%）（p 值=0.001）需要重建手术。随访时间不足 5 年的 469 例患者中有 23 例（4.9%）（p 值=0.01）发生侵蚀，随访时间超过 5 年的 388 例患者中有 27 例（6.9%）（p 值=0.001）发生侵蚀。
人工尿道括约肌在治疗 UI 时会引起并发症，如萎缩、侵蚀和感染；其发生的程度受到手术方法和人工尿道括约肌使用时间的影响。使用新的手术方法，如腹腔镜手术，似乎有助于降低并发症的发生率。
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