Sidi A A, Sinha B, Gonzalez R
J Urol. 1984 May;131(5):891-3. doi: 10.1016/s0022-5347(17)50696-5.
Artificial sphincter models AS791 and AS792 were used to treat 36 male and 7 female patients with urinary incontinence. Satisfactory results were obtained in 72 per cent of the patients. Of 100 surgical procedures performed to achieve these results 61 were planned procedures (initial implantation and delayed activation) and 39 were revisions required to improve continence, change mechanically failing devices or remove eroded sphincters. From our study 3 major problems with the artificial sphincter are apparent: 1) stress incontinence, which was present in 55 per cent of the patients with bulbous urethral sphincter compared to 21 per cent with sphincters located at the bladder neck, 2) erosions, which appear to be related to balloon pressure used and location of the artificial sphincter (there seems to be a higher incidence of erosions when the bulbous urethral site is used with balloon pressure greater than 80 cm. water) and 3) mechanical failures of the device, which accounted for 41 per cent of the unplanned operations in our series. These 3 major problems are reviewed, the possible etiology of persistent stress incontinence is discussed and possible ways to avoid these complications are suggested.
人工括约肌模型AS791和AS792用于治疗36例男性和7例女性尿失禁患者。72%的患者取得了满意的效果。为达到这些效果共进行了100例手术，其中61例为计划性手术（初次植入和延迟激活），39例为改善控尿、更换机械故障装置或取出侵蚀性括约肌所需的翻修手术。从我们的研究中可以明显看出人工括约肌存在3个主要问题：1）压力性尿失禁，球部尿道括约肌患者中55%存在该问题，而膀胱颈括约肌患者中为21%；2）侵蚀，这似乎与所用球囊压力及人工括约肌的位置有关（当球部尿道部位使用球囊压力大于80厘米水柱时，侵蚀发生率似乎更高）；3）装置机械故障，在我们的系列中占非计划性手术的41%。本文对这3个主要问题进行了综述，讨论了持续性压力性尿失禁的可能病因，并提出了避免这些并发症的可能方法。
