人工尿道括约肌植入术治疗前列腺术后尿失禁的临床疗效分析  

Clinical effect of artificial urinary sphincter implantation to treat post-prostatectomy incontinence

作　　者：张帆[1] 廖利民[1,2] ZHANG Fan;LIAO Limin(Department of Urology,China Rehabilitation Research Cente,Beijing Boai Hospital,Beijing,100068,China;Department of Urology,Capital Medical University)

机构地区：[1]中国康复研究中心北京博爱医院泌尿外科,北京100068 [2]首都医科大学泌尿外科学系

出　　处：《临床泌尿外科杂志》2022年第3期200-204,共5页Journal of Clinical Urology

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<0.0001];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<0.0001]。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。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.

关 键 词：人工尿道括约肌 前列腺术后尿失禁 并发症 结果 随访 

分 类 号：R694[医药卫生—泌尿科学]