Elliott D S, Barrett D M
Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 1998 Apr;159(4):1206-8.
We determine the long-term durability of the AMS 800* artificial urinary sphincter in the correction of severe urinary incontinence, and evaluate mechanical versus nonmechanical failure and reoperation rates before (1983 to 1987) and after (1988 to present) the introduction of the narrow backing occlusive cuff design.
From January 1983 to October 1994 more than 400 patients received an AMS 800 artificial urinary sphincter placed by 1 surgeon and 323, mean age 60.4 years, met study requirements for review. Mean followup was 68.8 months (range 18 to 153). Only patients with a minimum of 18 months of followup were included in the study. Of the 313 men and 10 women in the study group sphincters were placed at the urethra in 272 and at the bladder neck in 51. All patients were followed from surgery to the date of sphincter failure. Etiology of the failures was recorded and divided into mechanical versus nonmechanical sphincters placed before and after the introduction of the narrow backing cuff.
Overall, 58 of the 139 patients (42%) in the pre-narrow backing cuff group versus 31 of the 184 (17%) in the narrow backing cuff group required a first reoperation. Mechanical failure occurred in 29 cases (21%) with the pre-narrow backing and 14 (7.6%) with the narrow backing cuff. Nonmechanical failure developed in 24 cases (17%) with the pre-narrow backing and 17 (9%) with the narrow backing cuff. Ultimately 437 operations were required in the 323 patients, of whom 234 (72%) required no further surgical intervention at a mean followup of 68.8 months.
Technological advances in the design and construction of the AMS 800 have dramatically decreased the reoperation and failure rates. These advances and improved surgical techniques provide an excellent long-term solution and increased continence in correctly selected patients with urinary incontinence.
我们确定AMS 800*人工尿道括约肌在矫正严重尿失禁方面的长期耐用性，并评估在采用窄背封闭袖带设计之前（1983年至1987年）和之后（1988年至今）机械性与非机械性故障及再次手术率。
1983年1月至1994年10月，400多名患者接受了由1名外科医生植入的AMS 800人工尿道括约肌，其中323名患者（平均年龄60.4岁）符合研究复查要求。平均随访时间为68.8个月（范围18至153个月）。研究仅纳入随访至少18个月的患者。研究组的313名男性和10名女性中，272例括约肌置于尿道，51例置于膀胱颈。所有患者均从手术开始随访至括约肌失效日期。记录失败的病因，并分为机械性与非机械性，比较窄背袖带引入前后植入的括约肌情况。
总体而言，窄背袖带引入前的139例患者中有58例（42%）需要首次再次手术，而窄背袖带引入后的184例患者中有31例（17%）需要首次再次手术。窄背袖带引入前，29例（21%）发生机械性故障，窄背袖带引入后，14例（7.6%）发生机械性故障。窄背袖带引入前，24例（17%）发生非机械性故障，窄背袖带引入后，17例（9%）发生非机械性故障。323例患者最终共需要进行437次手术，其中234例（72%）在平均随访68.8个月时无需进一步手术干预。
AMS 800设计和构造方面的技术进步显著降低了再次手术率和故障率。这些进步以及改进的手术技术为正确选择的尿失禁患者提供了出色的长期解决方案，并提高了控尿能力。
