人工尿道括约肌植入术治疗骶髓损伤后压力性尿失禁

Implantation of artificial urinary sphincter for treatment of stress urine incontinence due to sacral cordinjury

目的评价人工尿道括约肌植入术（AUS）治疗骶髓损伤后压力性尿失禁的临床效果。方法 2010年3月至2012年10月,广州军区广州总医院泌尿外科全军泌尿外科中心收治了2例男性骶髓损伤后压力性尿失禁患者,术前采用影像尿流动力学检查、自由尿流率、脊髓磁共振、静脉肾盂造影检查、中段尿细菌培养、尿常规进行评估。行经会阴尿道球部人工尿道括约肌（AMS 800）植入术,并从术前开始口服抗胆碱能药物;术后第3、6个月行尿常规、超声、残余尿和尿流率检查。结果 2例患者随访9-12个月,术后完全控尿,未出现感染、侵蚀、尿道萎缩、装置机械故障等并发症。结论 AUS治疗骶髓损伤后压力性尿失禁,需要精确评估其膀胱及尿道功能,严格选择手术适应证,术后可获得满意控尿效果,同时需要长期密切随访。

Objective To evaluate the effects of implantation of artificial urinary sphincter（AUS） for treatment of patients with stress urine incontinence（SUI） due to sacral cordinjury. Methods From March2010 to October 2012 two male patients of stress urine incontinence due to spinal cord injury underwent video-urodynamics, free urinary flow rate, spinal cord MRI, intravenous pyelogram, urine bacterial culture and urine analysis. Both received implantation of AUS device（AMS 800）. Before surgery, patients had been treated with anticholinergic drugs. And urine test, urinary tract ultrasound, residual urine and urinary flow rate were examined at 3 and 6 months after surgery. Results Two patients were followed up for 9-12 months and achieved good continence. Infection, erosion, urethral atrophy, device mechanical failure and other complications hadn＇t occurred during follow up time. Conclusions It was very important to assess the pre-operative lower urinary tract function with SUI due to sacral cord injury by video-urodynamicsand and to manage indications for surgery. Patients may obtain satisfactory results of urine control after operation. It was necessary to follow up for long time closely.