哪种修复策略最适合男性人工尿失禁的非机械性故障？
Which revision strategy is the best for non-mechanical failure of male artificial urinary sphincter?
机构信息
Department of Urology, University of Bordeaux, Bordeaux, France.
Department of Urology, University of Rennes, Rennes, France.
出版信息
World J Urol. 2023 Dec;41(12):3663-3669. doi: 10.1007/s00345-023-04670-y. Epub 2023 Oct 30.
PURPOSE
Persistence or recurrence of stress urinary incontinence (prSUI) after artificial urinary sphincter (AUS) implantation may be secondary to non-mechanical failure (NOMECA). It have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men.
METHODS
NOMECA was defined as prSUI, with normally functioning device, no erosion, infection or fluid loss. Exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revisions for NOMECA, including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), three increasing balloon pressure (BALLOON-UP), were performed in 10 centers. BALLOON-UP patients weren't included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were also categorized in COMPLETE-CHANGE vs. PARTIAL-CHANGE of the device.
RESULTS
The three-months complete continence rate was 70.8% with a significant difference between RELOC and DOWNSIZING groups (p = 0.04). COMPLETE CHANGE was significantly associated with complete continence status at three months in multivariate analysis (83.3% vs. 63.3%, OR = 2.7; CI 95% [1.1-7.1], p = 0.03). Estimated five-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9% (p = 0.16; p = 0.30). Those were significantly longer in COMPLETE-CHANGE vs PARTIAL-CHANGE (82.2% vs. 69.6%, p = 0.03); (71.2% vs. 58.2%, p = 0.047).
CONCLUSIONS
AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff. COMPLETE-CHANGE may improve functional outcomes, explantation-free and reoperation-free survivals.
目的
人工尿道括约肌（AUS）植入后压力性尿失禁（SUI）的持续或复发可能继发于非机械性失败（NOMECA）。长期以来，人们一直认为这是尿道萎缩的结果。但目前对其存在仍存在争议。由于 NOMECA 的病理生理学尚未阐明，因此最适当的治疗方法仍不清楚。我们旨在比较男性 AUS 中几种用于 NOMECA 的翻修技术。
方法
NOMECA 被定义为 prSUI，设备功能正常，无侵蚀、感染或液体流失。排除标准为神经源性 SUI、因其他原因进行的翻修或取出。1991 年至 2022 年，在 10 个中心进行了 143 例 AUS 修复术，其中 99 例为袖套 DOWNSIZING，10 例为袖套重新定位（RELOC），13 例为 TANDEM-CUFF 放置，18 例为袖套更换（CHANGE），3 例为增加球囊压力（BALLOON-UP）。由于样本量小，BALLOON-UP 患者未纳入比较分析。所有部件均可在翻修过程中更换。患者还分为设备的完全更换（COMPLETE-CHANGE）与部分更换（PARTIAL-CHANGE）。
结果
三个月完全控尿率为 70.8%，RELOC 组和 DOWNSIZING 组之间存在显著差异（p=0.04）。多因素分析显示，完全更换与三个月时的完全控尿状态显著相关（83.3%比 63.3%，OR=2.7；95%CI [1.1-7.1]，p=0.03）。估计五年无再手术和无取出生存率分别为 63.4%和 75.9%（p=0.16；p=0.30）。完全更换组明显长于部分更换组（82.2%比 69.6%，p=0.03）；（71.2%比 58.2%，p=0.047）。
结论
由于 NOMECA 导致的 AUS 修复术治疗压力性尿失禁可获得满意的结果，无论使用何种技术。我们观察到重新定位新袖套时会有更好的功能结果。完全更换可能会改善功能结果、无取出和无再手术的生存率。
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