Fujino A, Maru N, Ohkawa A, Kurokawa J, Nagata M, Fukui J, Uchida T, Yokoyama E, Mashimo S, Koshiba K
Department of Urology, Takagi Hospital, Japan.
Nihon Hinyokika Gakkai Zasshi. 1995 Dec;86(12):1770-5. doi: 10.5980/jpnjurol1989.86.1770.
The aim of this study is to evaluate the therapeutic efficacy of artificial urinary sphincter AMS 800 implants for male patients with urinary incontinence.
Eleven male patients with urinary incontinence were treated by implantation of the artificial urinary sphincter AMS 800 between 1988 and 1992. Patient age at the surgery ranged from 14 to 79 years, with a mean age of 58 years. At presentation, 9 patients (82%) had true incontinence and 2 had overflow incontinence, and medical treatments and/or surgical procedures (Teflon injections in 2 and Sling procedure in 1) had been attempted previously elsewhere in all patients. The etiologies of incontinence were post-prostatectomy (transurethral resection in 4 and radical retropubic prostatectomy in 4) in 8 patients (73%) and myelomeningocele, spinal cord injury, pelvic trauma in one each. There were 5 patients with abnormal cystometrogram, and 2 of them were performing intermittent self catheterization. Vesicoureteral reflux was determined in 2 patients preoperatively, which were surgically corrected one year before AMS800 implant in a patient and simultaneously in another patient. The cuff was placed around the bulbous urethra (9), pendulous urethra (1) or bladder neck (1). The device was activated 6 weeks post implantation, and the assessment of therapeutic effects was started 2 weeks after activation.
Follow up ranged from 3 weeks to 75 months, with a mean of 56 months, if 3 cases done explantation due to periprosthetic infections were excluded. After AMS 800 implantation 5 patients (45%) were completely continent, 4(36%) required the use of not more than 1 pad per day, while a patient was not satisfied with the results and another patient was not definitive because of early explantation before device activation. Hence complete or near complete continence was achieved in 9 patients (81%). A patient is performing intermittent self catheterization in conjunction with the AMS 800 without any complications up until now. There were 3 periprosthetic infections (27%) associated with 2 cuff erosions, that consequently required explantation. Besides periprosthetic infection, neither complications nor mechanical device failures was experienced.
In conclusion, the AMS 800 artificial urinary sphincter was safe with reasonable mechanical reliability and offered acceptable and satisfactory urinary control to the selected patients with incontinence.
本研究旨在评估 AMS 800 人工尿道括约肌植入术对男性尿失禁患者的治疗效果。
1988 年至 1992 年间，11 例男性尿失禁患者接受了 AMS 800 人工尿道括约肌植入术。手术时患者年龄在 14 至 79 岁之间，平均年龄为 58 岁。就诊时，9 例（82%）为真性尿失禁，2 例为充溢性尿失禁，所有患者此前均在其他地方尝试过药物治疗和/或手术操作（2 例注射聚四氟乙烯，1 例进行吊带手术）。尿失禁的病因包括 8 例（73%）前列腺切除术后（4 例经尿道前列腺电切术，4 例耻骨后根治性前列腺切除术），1 例脊髓脊膜膨出、1 例脊髓损伤、1 例骨盆创伤。5 例患者膀胱测压异常，其中 2 例进行间歇性自我导尿。2 例患者术前检查发现膀胱输尿管反流，1 例患者在植入 AMS800 前 1 年进行了手术矫正，另 1 例患者在植入时同时进行了手术矫正。袖套置于球部尿道周围（9 例）、悬垂部尿道周围（1 例）或膀胱颈部（1 例）。植入后 6 周激活装置，激活后 2 周开始评估治疗效果。
随访时间为 3 周至 75 个月，平均 56 个月（排除 3 例因假体周围感染而取出装置的病例）。植入 AMS 800 后，5 例（45%）患者完全控尿，4 例（36%）患者每天使用不超过 1 片尿垫，1 例患者对结果不满意，另 1 例患者因装置激活前早期取出而未得出明确结果。因此，9 例（81%）患者实现了完全或接近完全控尿。1 例患者在使用 AMS 800 的同时进行间歇性自我导尿，至今未出现任何并发症。发生 3 例（27%）假体周围感染，伴有 2 例袖套糜烂，因此需要取出装置。除假体周围感染外，未出现其他并发症或机械装置故障。
总之，AMS 800 人工尿道括约肌安全，机械可靠性合理，为选定的尿失禁患者提供了可接受且令人满意的排尿控制。
