AdVance吊带球部尿道悬吊术与AUS植入术治疗中重度男性压力性尿失禁的长期疗效分析  

Long-term efficacy of AdVance obturator sling and artificial urethral sphincter in treatment of male stress urinary incontinence

作　　者：王起[1] 朱琳[1] 张维宇[1] 张晓鹏[1] 胡浩[1] 徐涛[1] 许克新[1] Wang Qi;Zhu Lin;Zhang Weiyu;Zhang Xiaopeng;Hu Hao;Xu Tao;Xu Kexin(Department of Urology,Peking University Peoples Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《中华泌尿外科杂志》2022年第9期686-689,共4页Chinese Journal of Urology

摘　　要：目的评估AdVance吊带球部尿道悬吊术和人工尿道括约肌(AUS)植入术治疗中重度男性压力性尿失禁的长期疗效。方法回顾性分析2011年6月至2017年6月于北京大学人民医院行手术治疗的12例男性尿失禁患者的临床资料。年龄中位值75(64~80)岁。其中根治性前列腺切除术后9例,经尿道前列腺切除术后3例。尿失禁病史中位值3(1~9)年,每日使用尿垫量中位值8(5~10)片。其中5例为中度尿失禁,7例为重度尿失禁。12例中6例行AdVance吊带球部尿道悬吊术(为AdVance组),6例行AUS植入术(为AUS组)。AdVance组年龄中位值72(64~73)岁;每日使用尿垫量中位值6(5~8)片;尿失禁生活质量问卷(I-QOL)评分(15.0±5.4)分;5例为中度尿失禁,1例为重度尿失禁。AUS组年龄中位值78(76~80)岁,每日使用尿垫量中位值8(6~10)片,I-QOL评分(16.7±5.1)分,均为重度尿失禁。记录患者术后1、5年的每日尿垫使用量、I-QOL评分,同时记录术后并发症情况。结果所有手术均顺利完成。术后随访5~7年,平均5.5年。AdVance组术后1年,1例重度尿失禁患者术后症状较术前无明显改善;其余5例尿失禁症状改善明显,每日尿垫使用量中位值为1(1~2)片;AdVance组6例每日尿垫使用量中位值为2.5(1~10)片,I-QOL评分(75.0±28.1)分,均较术前改善明显(P<0.05)。AdVance组术后5年每日尿垫使用量中位值2.5(1~10)片,I-QOL评分(78.3±29.3)分,均较术前明显改善(P<0.01)。AUS组术后1年,患者均无需使用尿垫,I-QOL评分(91.6±7.5)分,均较术前改善明显(P<0.01);2例于术后3年出现尿道侵蚀,取出人工尿道括约肌,尿失禁复发,恢复到术前状态,未再次手术;其余4例术后5年均不需要使用尿垫。AdVance组3例术后3个月内出现会阴部疼痛,与活动相关,均自行缓解;无伤口感染、尿道侵蚀等并发症发生。AUS组3例出现尿道侵蚀。结论AdVance吊带球部尿道悬吊术对中度压力性尿失禁患者疗效较好,且并发症少;AUS植入�Objective To evaluate the long-term efficacy of AdVance sling bulbar urethral suspension and artificial urethral sphincter(AUS)implantation in the treatment of moderate to severe male stress urinary incontinence.MethodsThe clinical data of 12 male patients with urinary incontinence who underwent surgical treatment in Peking University People's Hospital from June 2011 to June 2017 were retrospectively analyzed.The median age was 75(64-80)years.There were 9 cases after radical prostatectomy and 3 cases after transurethral prostatectomy.Patients had a median history of urinary incontinence of 3(1-9)years,and needed an average of 8(5-10)pads per day.Among them,5 patients had moderate urinary incontinence and 7 patients had severe urinary incontinence.All patients underwent urinary incontinence surgery for the first time.Among the 12 patients,6 received AdVance sling ball urethral suspension(AdVance group),and 6 received AUS implantation(AUS group).The median age of the AdVance group was 72(64-73)years.The median number of pads used daily was 6(5-8)tablets.Urinary incontinence Quality of Life questionnaire(I-QOL)score was(15.0±5.4).Five patients had moderate urinary incontinence and one patient had severe urinary incontinence.In the AUS group,the median age was 78(76-80)years old,the median daily pad use was 8(6-10)tablets,and the I-QOL score was(16.7±5.1),all of which were severe urinary incontinence.The daily pad usage,I-QOL and postoperative complications were recorded at 1 and 5 years after operation.Results All patients completed the operation successfully.The postoperative follow-up was 5-7 years(mean 5.5 years).In AdVance group,1 patient with severe urinary incontinence had no significant improvement in postoperative symptoms at 1 year after operation.The other 5 patients showed significant improvement in urinary incontinence symptoms.In the AdVance group,the median number of pads used per day was 2.5(1-10),and the IQOL score was(75.0±28.1),which were all significantly improved compared with that before oper

关 键 词：尿失禁 压力性 男性 人工尿道括约肌植入术 AdVance吊带球部尿道悬吊术 

分 类 号：R699.6[医药卫生—泌尿科学]