Clinical effect of artificial urinary sphincter implantation to treat post-prostatectomy incontinence
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摘要: 目的 总结人工尿道括约肌(artificial urinary sphincter，AUS)植入术用于治疗前列腺术后尿失禁经验。方法 回顾性分析2002年4月—2021年11月中国康复研究中心12例前列腺术后尿失禁行人工尿道括约肌植入术患者的资料。患者平均年龄(68.5±6.5)岁，其中前列腺癌根治术后尿失禁8例，前列腺增生术后尿失禁4例。比较不同类型前列腺术后尿失禁患者尿动力学特点，对人工尿道括约肌植入手术后并发症处理及患者尿失禁和生活质量改善情况进行评估。结果 术后平均随访时间4.5年。截至最近一次随访，10例患者仍然使用初次安装的括约肌装置，手术成功率83.3%。术后10例患者达到社交控尿，其中8例患者达到完全干燥。患者术后尿垫使用量较术前显著下降[(3.9±1.4)片/d vs.(1.1±1.1)片/d，P< 0.000 1]；尿失禁影响生活质量评分较术前显著改善[(8.3±1.0)分vs.(2.7±1.2)分，P< 0.000 1]。术后并发症发生率为16.7%，其中1例患者因尿道溶蚀取出装置，1例患者因排尿困难行膀胱造瘘。结论 人工尿道括约肌植入术为中-重度前列腺术后尿失禁的有效治疗方法。术前下尿路功能全面评估及术后严密随访有助于提高手术成功率。Abstract: Objective To summarize the experience of artificial urinary sphincter implantation in patients with post-prostatectomy incontinence.Methods Between April 2002 and November 2021, a total of 12 patients, median age(68.5±6.5) years with urinary incontinence had undergone artificial urinary sphincter placement. The patients category were post radical prostatectomy (n=8), post TURP (n=4). Assessments included preoperative urodynamic characteristics, postoperative urinary continence rate, artificial urinary sphincter status, complications, quality of life and additional procedures.Results The mean follow-up time was 4.5 years ranged from 6 months to 10 years. At the latest visit, 10 patients maintained the primary artificial urinary sphincter, leading to the overall success rate as 83.3%. Ten patients were socially continent, of which eight patients were totally dry. There was a significant reduction in pad count from (3.9±1.4) to (1.1±1.1) diapers per day (P< 0.000 1). There was a significant reduction on the impact of urinary incontinence on QoL, with a decrease from (8.3±1.0) to (2.7±1.2) (P< 0.000 1) measured by VAS. The complication rate was 16.7%, including infection and erosion (n=1) and dysuria (n=1). Explantations were performed in one patient.Conclusion Artificial urinary sphincter implantation is an effective treatment method for patients with moderate to severe post-prostatectomy incontinence. Preoperative comprehensive assessment of lower urinary tract function and postoperative close follow-up can improve operative successful rate.
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Key words:
- artificial urinary sphincter /
- post-prostatectomy incontinence /
- complication /
- outcomes /
- follow up
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表 表 1 12例PPI患者基本情况及术前尿动力参数
X±S 指标 总体(n=12) TURP组(n=4) RP组(n=8) t P值 年龄/岁 68.5±6.5 64.5±5.1 70.5±6.4 1.62 0.14 病史/年 4.3±1.6 6.5±4.5 3.1±1.2 0.97 0.35 BMI/(kg·m-2) 25.2±1.6 24.9±2.1 25.3±1.7 0.32 0.76 尿动力学参数 MBC/mL 246.1±92.1 176.5±50.9 285.9±23.6 2.24 ＞0.05 BC/(mL·cmH2O-1) 24.8±17.3 15.0±7.5 30.4±6.4 1.52 0.16 DO/例(%) 3(25.0) 1(25.0) 2(25.0) - 1.00 LBC/例(%) 4(33.3) 3(75.0) 1(12.5) - 0.06 人工尿道括约肌植入术式/例 经会阴双切口 3 2 1 经阴囊单切口 5 1 4 经会阴单切口 4 1 3 袖套尺寸/cm 4.0 6 2 4 4.5 6 2 4 注：TURP组与RP组AUS术前尿动力学参数比较差异无统计学意义。最大膀胱测压容量(maximum bladder capacity，MBC)；膀胱顺应性(bladder compliance，BC)；逼尿肌过度活动(detrusor overactivity，DO)；膀胱顺应性下降(low bladder compliance，LBC)。 
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表 表 2 患者术后并发症及控尿情况
指标 总体(n=12) RP组(n=8) TURP组(n=4) 处理 P值 并发症/例(%) 2(16.7) 1(12.5) 2(50.0) 术后血尿 11) - 留置尿管引流 皮肤感染 - 12) 取出装置 尿道溶蚀 - 12) 排尿困难 - 13) 膀胱造瘘 社交控尿/例(%) 10(83.3) 8(100.0) 2(50.0) 0.09 完全干燥/例(%) 8(66.7) 7(87.5) 1(25.0) 0.07 注：社交控尿定义为每日使用≤1片尿垫，完全干燥率为每日完全无需尿垫。1)1例患者术后1周发生血尿，保守治疗后缓解，术后4周成功激活装置并达到完全干燥(未记入远期随访并发症)。2)同一例患者术后4年发生尿道袖套溶蚀伴尿液外渗及皮肤感染后取出全套装置。3)1例患者术后2年因脑血管病合并退行性神经系统疾病不能自主控制装置并出现排尿困难，后行膀胱造瘘。
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