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Abstract：
To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study.
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.
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.
摘要：
在一项大型中欧多中心队列研究中，分析人工括约肌（AMS800）的植入体积对预后的影响。
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。
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。
