Martins F E, Boyd S D
Department of Urology, University of Southern California School of Medicine, Los Angeles, USA.
Br J Urol. 1995 Mar;75(3):354-8. doi: 10.1111/j.1464-410x.1995.tb07348.x.
To determine the incidence of infection-erosion associated with the implantation of artificial urinary sphincters (AMS 800) in a high-risk group of patients (post-major pelvic surgery/radiotherapy), and to emphasize the commonly neglected risk factors associated with this complication.
One-hundred-and forty-five male patients aged 55-79 years (mean 71) who had had an AMS 800 artificial sphincter implanted between January 1987 and November 1993 were reviewed. All patients had undergone meticulous surgical technique, intra-operative shave and rigorous scrub, and were given peri-operative antibiotics. The mean follow-up was 34.3 months (range 1-83).
Infection-erosion occurred in 13 patients (9%), of whom 10 are currently available for follow-up. One patient died of his underlying disease (bladder cancer) and two were lost to follow-up. All 13 patients had undergone radical pelvic surgery (radical retropubic prostatectomy, radical cystectomy and abdominoperineal resection); seven patients had also received radiation therapy. Cultures of the infected AMS 800 devices revealed a pleomorphic group of organisms, specifically enteric, Gram-positive and anaerobic organisms. The risk of infection-erosion was found to be increased in the presence of two main factors, improper urethral catheterization and urethral endoscopic manipulation with an activated AMS 800 artificial sphincter in place and exposure to radiation. At the time of revision, nine of the 13 patients were found to have positive urine cultures.
Despite all the precautions taken, there remains a group of patients who are still at a higher risk of infection-erosion due to adverse circumstances that distort the anatomy of the perineal area, impair the host defence mechanisms, and ultimately enable the establishment of the infection-erosion complex. Radiotherapy is known to increase the likelihood of non-mechanical complications, specifically infection-erosion. Extreme care must be taken so that avoidable iatrogenic factors such as improper urethral catheterization and endoscopic manipulation with an activated AMS 800 device in situ are not the cause of 'failure'.
确定在高危患者群体（重大盆腔手术后/放疗后）中植入人工尿道括约肌（AMS 800）相关的感染-侵蚀发生率，并强调与该并发症相关的常被忽视的危险因素。
回顾了1987年1月至1993年11月期间植入AMS 800人工括约肌的145例年龄在55 - 79岁（平均71岁）的男性患者。所有患者均接受了细致的手术操作、术中剃须和严格的擦洗，并给予围手术期抗生素。平均随访时间为34.3个月（范围1 - 83个月）。
13例患者（9%）发生感染-侵蚀，其中10例目前仍在接受随访。1例患者死于基础疾病（膀胱癌），2例失访。所有13例患者均接受了根治性盆腔手术（根治性耻骨后前列腺切除术、根治性膀胱切除术和腹会阴联合切除术）；7例患者还接受了放射治疗。对感染的AMS 800装置进行培养显示有一群多形性生物体，特别是肠道、革兰氏阳性和厌氧生物体。发现存在两个主要因素时感染-侵蚀风险增加，即不当的尿道插管以及在激活的AMS 800人工括约肌在位的情况下进行尿道内镜操作和接受放疗。在翻修时，13例患者中有9例尿液培养呈阳性。
尽管采取了所有预防措施，但仍有一组患者因不利情况而面临更高的感染-侵蚀风险，这些不利情况会扭曲会阴区解剖结构、损害宿主防御机制，并最终导致感染-侵蚀复合体的形成。已知放疗会增加非机械性并发症的可能性，特别是感染-侵蚀。必须格外小心，以免诸如不当的尿道插管和在激活的AMS 800装置在位时进行内镜操作等可避免的医源性因素成为“失败”的原因。
