Lin Jeffery S, Skokan Alexander J, Wessells Hunter, Hagedorn Judith C
Department of Urology, University of Washington, Seattle, WA, USA.
Transl Androl Urol. 2023 May 31;12(5):898-917. doi: 10.21037/tau-22-727. Epub 2023 Mar 7.
The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.
A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent.
Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation.
A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.
人工尿道括约肌(AUS)仍是治疗压力性尿失禁(SUI)的金标准。然而,对于诸如球部尿道受损、膀胱病变及下尿路并发症等病情高度复杂的患者,外科医生面临着特殊挑战。在本文中,我们将探讨关键风险因素,并综合相关疾病状态下的现有数据,以支持外科医生成功管理高危患者的SUI。
使用搜索词“人工尿道括约肌”并结合以下任何一个附加词对当前文献进行全面综述:“放疗”“尿道狭窄”“后尿道狭窄”“膀胱尿道吻合口狭窄”“膀胱颈挛缩”“骨盆骨折尿道损伤”“阴茎血管重建”“可膨胀阴茎假体”及“侵蚀”。在现有文献稀少或不存在的情况下,依据专家意见提供指导。
几个已知的患者风险因素与AUS失效相关,并最终可能导致装置取出。在植入装置前,每个风险因素都需要仔细考虑、调查或进行适当干预。对于这些高危患者,优化尿道健康、确认下尿路的解剖和功能稳定性以及对患者进行全面咨询是必要的。可以考虑几种减少装置并发症的手术策略:优化睾酮水平、避免使用3.5厘米的AUS袖带、经体部放置AUS袖带、重新定位AUS袖带位置、使用低压调节球囊、阴茎血管重建以及夜间间歇性停用。
一些患者风险因素与AUS失效相关,并最终可能导致装置取出。我们提出了一种高危患者管理算法。对于这些高危患者,优化尿道健康、确认下尿路的解剖和功能稳定性以及对患者进行全面咨询是必要的。