Weis Sylvia, Ludwig Tim A, Bahassan Omar, Gild Philipp, Vetterlein Malte W, Fisch Margit, Dahlem Roland, Maurer Valentin
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Int Neurourol J. 2023 Jun;27(2):139-145. doi: 10.5213/inj.2346030.015. Epub 2023 Jun 30.
This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS).
Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed.
Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months.
Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.
本研究调查了人工尿道括约肌（AUS）植入术后男性复发性或持续性压力性尿失禁（SUI）患者进行袖带缩小术的功能结局和并发症发生率。
对我们机构2009年至2020年期间AUS数据库中的数据进行回顾性分析。确定每日使用的尿垫数量，发放标准化生活质量（QoL）问卷和国际尿失禁咨询问卷（ICIQ），并根据Clavien-Dindo分类法分析术后并发症。
在研究期间接受AUS植入的477例患者中，25例（5.2%）接受了袖带缩小术（中位年龄77岁；四分位间距[IQR]为74 - 81岁；中位随访时间4.4年；IQR为3 - 6.9年）。在缩小术之前，80%的患者SUI非常严重（ICIQ评分19 - 21）或严重（ICQ评分13 - 18），12%为中度（ICIQ评分6 - 12），8%为轻度（ICIQ评分1 - 5）。缩小术后，52%的患者在21分中改善超过5分。然而，28%的患者仍有非常严重或严重的SUI，48%有中度SUI，20%有轻度SUI。1例患者不再有SUI。52%的患者每日尿垫使用量减少≥50%。56%的患者QoL在6分中改善超过2分。36%的患者发生需要取出装置的并发症（感染/尿道侵蚀），事件发生的中位时间为14.5个月。
尽管袖带缩小术有取出AUS的风险，但对于AUS植入术后持续性或复发性SUI的特定患者，它可能是一种有价值的治疗选择。超过一半的患者在症状、满意度、ICIQ评分和尿垫使用方面有改善。告知患者AUS的潜在风险和益处对于管理他们的期望和评估个体风险很重要。
