Girard Camille, El-Akri Mehdi, Durand Matthieu, Guérin Olivier, Cornu Jean-Nicolas, Brierre Thibaut, Cousin Tiffany, Gaillard Victor, Dupuis Hugo, Tricard Thibault, Hermieu Nicolas, Leon Priscilla, Chevallier Daniel, Bruyere Franck, Biardeau Xavier, Hermieu Jean-François, Lecoanet Pierre, Capon Gregoire, Game Xavier, Saussine Christian, Rambaud Cyrielle, Peyronnet Benoit, Bentellis Imad
University Hospital of Nice, Nice, France.
University Hospital of Rennes, Rennes, France.
Eur Urol Open Sci. 2023 May 16;53:23-30. doi: 10.1016/j.euros.2023.03.014. eCollection 2023 Jul.
Artificial urinary sphincter (AUS) is a gold standard treatment in male stress urinary incontinence but remains poorly used in elderly patients.
To assess the efficacy, safety, and reoperation-free survival of AUS implantation in male patients over 75 yr of age.
We retrospectively reviewed the charts of all 1233 non-neurological male AUS implantations between 2005 and 2020 at 13 French centers. We compared 330 patients ≥75 yr old (GROUP75+) with 903 patients <75 yr old (GROUP75-) at the time of AUS implantation.
Our primary endpoint was social continence at 3 mo defined as the use of one or fewer pad daily. We used Kaplan-Meier analyses to assess reoperation-free survival. We sought factors of erosion using logistic regression.
Early postoperative continence was comparable in both groups (74.4% vs 80.1%, 0.114). We observed a higher rate of postoperative complications in GROUP75+ (18.8% vs 12.6%, 0.014), but the complications were more frequently of low grade in GROUP75+ ( 0.025). The overall reoperation-free survival was similar ( 0.076) after a median follow-up of 2 yr. However, patients in GROUP75+ had poorer explantation-free survival ( < 0.0001). A history of radiotherapy was a predictive factor of erosion (odds ratio [OR] 5.31, < 0.01), but age was not (OR 1.08, 0.87). Unfortunately, our dataset did not include a systematic geriatric evaluation.
AUS in elderly patients appears to be an effective option to treat stress urinary incontinence. However, we observed more postoperative complications and explantations, although age was not associated with the onset of erosion. A prospective study is required to determine whether a geriatric evaluation would be an effective strategy to select patients before surgery.
In this study, we looked at outcomes of artificial urinary sphincter in elderly men in a large population. We found satisfying efficacy but slightly more postoperative complications and device infections.
人工尿道括约肌（AUS）是男性压力性尿失禁的金标准治疗方法，但在老年患者中的应用仍然较少。
评估75岁以上男性患者植入AUS的疗效、安全性和无再次手术生存期。
设计、地点和参与者：我们回顾性分析了2005年至2020年期间法国13个中心的1233例非神经源性男性AUS植入手术记录。我们比较了330例年龄≥75岁（75岁以上组）和903例年龄<75岁（75岁以下组）的AUS植入患者。
我们的主要终点是术后3个月时的社会控尿，定义为每天使用一个或更少尿垫。我们使用Kaplan-Meier分析评估无再次手术生存期。我们通过逻辑回归寻找侵蚀的相关因素。
两组术后早期控尿情况相当（74.4%对80.1%，P = 0.114）。我们观察到75岁以上组术后并发症发生率较高（18.8%对12.6%，P = 0.014），但75岁以上组的并发症多为低级别（P = 0.025）。中位随访2年后，总体无再次手术生存期相似（P = 0.076）。然而，75岁以上组患者的无取出装置生存期较差（P < 0.0001）。放疗史是侵蚀的预测因素（比值比[OR] = 5.31，P < 0.01），但年龄不是（OR = 1.08，P = 0.87）。不幸的是，我们的数据集中没有包括系统的老年评估。
老年患者植入AUS似乎是治疗压力性尿失禁的有效选择。然而，我们观察到更多的术后并发症和装置取出情况，尽管年龄与侵蚀的发生无关。需要进行前瞻性研究以确定老年评估是否是术前选择患者的有效策略。
在本研究中，我们观察了大量老年男性人工尿道括约肌的治疗结果。我们发现疗效令人满意，但术后并发症和装置感染略多。
