Martins F E, Boyd S D
Department of Urology, University of Southern California Medical Center, Los Angeles.
J Urol. 1995 Apr;153(4):1188-93.
Between January 1988 and December 1992 the AMS800* artificial urinary sphincter was inserted in 81 men with urinary incontinence due to major pelvic surgery and/or radiation therapy. Radical retropubic prostatectomy had been performed in 38 men, radical retropubic prostatectomy with adjuvant radiation in 28, definitive radiation therapy for prostatic carcinoma in 5, abdominoperineal resection with adjuvant radiation in 1 and radical cystectomy with orthotopic urinary diversion in 8, while 1 suffered major pelvic trauma with urethral rupture. A bulbar urethral cuff was used exclusively, with pressure regulating balloons of 51 to 60 and 61 to 70 cm. water. The interval for primary activation ranged from 4 to 12 weeks (mean 7.7), with all irradiated patients waiting 12 weeks. Surgical revision was required in 38% of the patients totaling 43 operations. Inadequate cuff compression after presumed urethral atrophy secondary to hypovascularity accounted for 74% of the procedures, whereas infection with or without erosion necessitated 8 revisions, mostly attributable to improper placement elsewhere of an indwelling catheter after the artificial urinary sphincter had been activated. Mechanical malfunction was responsible for 7% of the revisions. Overall, socially acceptable continence was achieved in 91% of the study population. Despite a significantly greater need for revision in this high risk group (38% versus 22% in the literature for low risk groups) with meticulous surgical and sterile techniques as well as diligent followup, the long-term outcome in terms of continence and device survival may be excellent regardless of the underlying etiology. We conclude that use of the AMS800 artificial sphincter for significant male urinary incontinence is undoubtedly the most efficacious treatment currently available for which even the most adverse candidate should not necessarily be excluded.
1988年1月至1992年12月期间，81名因盆腔大手术和/或放射治疗导致尿失禁的男性患者植入了AMS800*人工尿道括约肌。38名男性患者接受了根治性耻骨后前列腺切除术，28名患者接受了根治性耻骨后前列腺切除术并辅助放疗，5名患者接受了前列腺癌的根治性放疗，1名患者接受了腹会阴联合切除术并辅助放疗，8名患者接受了根治性膀胱切除术并原位尿流改道术，另有1名患者发生严重盆腔创伤伴尿道破裂。仅使用球部尿道袖带，压力调节球囊压力为51至60厘米水柱和61至70厘米水柱。初次激活的间隔时间为4至12周（平均7.7周），所有接受放疗的患者均等待12周。38%的患者需要进行手术翻修，共计43次手术。因血管减少继发尿道萎缩后袖带压迫不足占手术的74%，而感染伴或不伴糜烂需要8次翻修，主要归因于人工尿道括约肌激活后留置导尿管在其他部位放置不当。机械故障占翻修的7%。总体而言，91%的研究人群实现了社会可接受的控尿。尽管该高风险组的翻修需求明显更高（38%，而文献中低风险组为22%），但通过细致的手术和无菌技术以及勤勉的随访，无论潜在病因如何，在控尿和装置存活方面的长期结果可能都很出色。我们得出结论，对于男性严重尿失禁，使用AMS800人工括约肌无疑是目前最有效的治疗方法，即使是最不利的患者也不一定应被排除。
