人工尿道括约肌治疗神经源性尿失禁11例疗效分析

Efficacy of artificial urinary sphincter implantation in the treatment of neurogenic urinary incontinence:A report of 11 cases

目的报道人工尿道括约肌(AUS)植入治疗神经源性尿失禁(NUI)的经验。方法回顾性分析我中心2002年4月至2020年2月11例NUI患者行AUS植入的临床资料。对前期尿路修复手术、术后装置使用、患者控尿和生活质量改善及并发症处理进行评价。结果术后平均随访时间8.6年。6例(54.5%)患者使用初次安装装置,2例(18.2%)患者行一次修复手术,3例(27.3%)患者因并发症取出装置。术后7例患者达到社会控尿,其中6例患者达到完全干燥,手术成功率63.6%。患者术后尿垫使用量较术前显著下降[(4.2±0.9)片/d vs.(2.1±1.7)片/d,P<0.05)];术后并发症发生率为45.4%(5例),其中皮肤感染2例、尿道溶蚀1例、排尿困难1例、持续尿失禁1例。结论AUS植入是NUI有效的治疗方法。特别对复杂尿路重建需根据患者个体情况制定方案。手术时机及治疗选择应更加谨慎。术后需全尿路长期随访。

Objective To present our experience of artificial urinary sphincter(AUS)implantation in patients with neurogenic urinary incontinence(NUI).Methods The clinical data of 11 NUI patients treated with AUS placement during Apr.2002 and Feb.2020 were retrospective analyzed.The urinary tract reconstruction,use of AUS,urinary control,quality of life and complications were assessed.Results During the mean follow-up of 8.6 years,6 patients(54.5%)maintained the primary AUS,2(18.2%)had AUS repaired,3(27.3%)had AUS removed due to complications;7 patients had social urinary continence,6 of whom had total control,and the overall success rate was 63.6%(7/11).There was a significant reduction in pad count from(4.2±0.9)to(2.1±1.7)diapers perday(P<0.05).The complication rate was 45.5%,including skin infection in 2 cases,urethral erosion in 1 case,dysuria in 1 case,and persistent incontinence in 1 case.Conclusion AUS implantation is an effective treatment for NUI patients requiring urinary tract reconstruction.The timing of AUS placement and choice of management modalities should be tailored to the individual needs.Long-term entire urinary tract follow-up is needed.