Scott F B, Fishman I J, Shabsigh R
J Urol. 1986 Sep;136(3):636-42. doi: 10.1016/s0022-5347(17)45000-2.
The charts and x-rays of 120 neurogenic bladder patients who underwent artificial sphincter implantation for treatment of urinary incontinence between 1973 and 1984 were reviewed retrospectively. Patients were followed for 3 to 130 months (average 36.8 months). The upper urinary tracts remained unchanged in 108 patients (90 per cent). Renal growth in children was undisturbed. Transient hydroureteronephrosis occurred in 8 patients (6.7 per cent) and progressive hydroureteronephrosis occurred in 4 (3.3 per cent). A total of 26 patients with vesicoureteral reflux (39 ureters) underwent ureteral reimplantation. Our results indicate that implantation of the artificial urinary sphincter in neurogenic bladder patients has minimal adverse impact on the upper urinary tracts, followup should be long-term and should include an IVP, outflow obstruction should be eliminated preoperatively by means of external sphincterotomy in male patients and bladder flap urethroplasty in female patients, similarly, adequate emptying of the bladder always must be assured during followup, if hydroureteronephrosis is detected early appropriate treatment can restore normal upper tracts, the presence of previously damaged upper tracts without evidence of obstruction is not a contraindication for artificial sphincter implantation and an antireflux operation in combination with artificial sphincter implantation is feasible.
回顾性分析了1973年至1984年间120例因尿失禁接受人工括约肌植入术治疗的神经源性膀胱患者的图表和X光片。对患者进行了3至130个月的随访（平均36.8个月）。108例患者（90%）上尿路保持不变。儿童肾脏生长未受干扰。8例患者（6.7%）出现短暂性输尿管肾积水，4例患者（3.3%）出现进行性输尿管肾积水。共有26例膀胱输尿管反流患者（39条输尿管）接受了输尿管再植术。我们的结果表明，在神经源性膀胱患者中植入人工尿道括约肌对上尿路的不良影响最小，随访应长期进行并应包括静脉肾盂造影，男性患者术前应通过外括约肌切开术、女性患者应通过膀胱瓣尿道成形术消除流出道梗阻，同样，随访期间必须始终确保膀胱充分排空，如果早期发现输尿管肾积水，适当治疗可恢复上尿路正常，存在先前受损但无梗阻证据的上尿路不是人工括约肌植入的禁忌证，并且人工括约肌植入联合抗反流手术是可行的。
