As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high-volume centers.
Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high-volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P < .001), used the perineal approach significantly more often (78% vs 67.7%; P = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P = .002). With a mean follow-up of 18 months, the revision rate was significantly higher at low-volume centers (38.5% vs 26.7%; P = .037), urethral erosion being the main reason for revision. Social continence (0-1 pads/24 h) was achieved significantly more often in high-volume centers (45.5% vs 24.2%; P = .002).
Our study showed significantly better continence results and lower revision rates at high-volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.
作为DOMINO(男性失禁辩论)项目的一部分,我们对2010~2012年间接受人工括约肌(AMS800)治疗的473例患者的手术方式和结局进行了回顾性分析.每年植入至少10个AMS800的诊所被定义为高容量中心。
16个中心的平均比率为9.54AMS800/y,其中5个诊所被确定为高容量中心。他们植入了明显更多的双袖口(55%vs12.1%;P<.001),使用会阴入路的频率明显更高(78%vs67.7%;P=.003),并选择了较大的平均袖口尺寸(4.63cmvs4.42cm;P=.002).平均随访18个月,低容量中心的翻修率明显更高(38.5%vs26.7%;P=.037),尿道糜烂是修正的主要原因。在高容量中心,实现社会节制(0-1垫/24小时)的频率明显更高(45.5%vs24.2%;P=.002)。
我们的研究表明,在高容量中心,节制效果明显更好,翻修率更低,证实了在这十年中仍然存在的早期结果。我们,因此,建议在合格的中心进行男性失禁手术。