人工尿道括约肌植入术重建控尿功能的远期随访效果

Long-term follow-up of reconstruction for urinary continence function using implantation of artificial urinary sphincter

目的探讨人工尿道括约肌植入术重建控尿功能的长期效果。方法尿失禁患者15例。男14例，女1例。年龄19～75岁。其中外伤性完全性尿失禁5例、神经性压力性尿失禁1例、神经性反射性尿失禁1例、前列腺术后尿失禁6例、神经性排尿障碍2例。患者术前行尿道狭窄切开术3例、尿道括约肌切开术3例、肠道膀胱扩大及输尿管抗反流术1例。植入人工尿道括约肌（AUs），男性袖套植于球部尿道、控制泵植于阴囊，女性袖套植于膀胱颈、控制泵植于大阴唇下，储水囊植于膀胱外盆腔。15例随访13～55个月，平均37个月，观察控尿和尿垫使用及并发症发生情况。结果15例患者术后AUS正常使用13例（87％），其中完全控尿者12例（92%）、社交可接受性控尿1例（8％）。依靠原始植入装置控尿者11例（85％）、经修复术后控尿者2例（15％）。发生并发症4例（27％），其中阴囊皮肤及尿道侵蚀、异物反应、尿道萎缩、排尿困难各1例，2例取出装置。随访期内11例依靠原始植入装置控尿者装置使用期为13～55个月，平均38个月。结论AUS植入术是下尿路功能重建中一种长期可靠的方法。

Objective To evaluate the long term outcome of reconstruction for urinary conti nence function by using implantation of artificial urinary sphincter （AUS）. Methods From 2002 to 2005,15 incontinent patients （14 men and 1 woman） with age range of 19- 75 years treated with implantation of AUS were followed up. In 15 cases, there were 5 cases with traumatic urinary incontinence, 1 with neurogenic stress incontinence, 1 with neurogenic urgent incontinence,6 with postprostatectomy incontinence and 2 with neurogenic voiding dysfunction. Three cases had taken urethrostenotomy, 3 had sphincterotomy and 1 had enterocystoplasty and ureterovesicostomy before the implantation for AUS. The patients were followed up for 13-55 months with mean of 37 months. The information about the continence status and pads usage, also the complications were collected. Results After implantation, 13 cases（87%）used AUS device normally, 12（92%）became dry and 1 （8%）got social continence. Eleven cases （85%） got continence depending on the original implanted AUS and 15 % did continence by reoperation. There were 4 cases（27%） with complications including erosion of skin and urethral in 1, graft rejection in 1, urethral atrophy in 1, and voiding dysfunction in 1. Durability of 11 cases with original implanted devices was 13 -55 months with mean of 38 months. Conclusion The implantation of AUS is a long-term reliable method in reconstruction for lower urinary tract function.