人工尿道括约肌(AUS)是男性压力性尿失禁(SUI)的有效治疗方法。然而,感染,侵蚀,机械故障,萎缩,和球囊恶化导致大约一半的患者在植入后10年发生设备故障。许多患者希望恢复尿失禁并需要进行翻修手术(RS),包括装置移除和同时或延迟植入。应对考虑RS的患者进行身体检查,并通过访谈检查是否有感染迹象。应使用膀胱镜检查评估尿道糜烂。如果有感染或侵蚀,所有的设备应该首先被删除,几个月后应该植入新设备。在RS期间,在尿道周围强烈粘附后,跨体袖带植入是一个安全的选择。可以在没有感染或侵蚀的情况下进行装置移除和同时植入。如果植入后已经过了很长时间,由于设备老化和退化,应更换整个设备;但是,如果时间很短,只有有缺陷的组件需要更换。术中评估尿道健康状况对于移除和植入装置是必要的。如果尿道是健康的,可以将新的袖带放置在与旧袖带移除相同的位置;但是,如果尿道不健康,袖带可以植入在更近/远的位置,或者可以选择跨体囊植入物。本文回顾了有关AUS男性患者复发性SUI的诊断和治疗策略的文献,并提出了AUS修订的流程图。
Artificial urinary sphincters (AUS) are an effective treatment for male stress urinary incontinence (SUI). However, infection, erosion, mechanical failure, atrophy, and balloon deterioration cause device malfunction in approximately half of patients by 10 years after implantation. Many patients desire to regain urinary continence and require revision surgery (RS), including device removal and simultaneous or delayed implantation. Patients for whom RS is considered should be examined physically and by interview for signs of infection. Urethral erosion should be assessed using cystoscopy. If there is infection or erosion, all devices should be removed first, and a new device should be implanted several months later. During the RS, after strong adhesion around the
urethra, transcorporal cuff implantation is a safe choice. Device removal and simultaneous implantation can be performed in the absence of infection or erosion. If a long time has passed since device implantation, the entire device should be replaced due to device aging and deterioration; however, if the time is short, only the defective component need be replaced. Intraoperative assessment of urethral health is necessary for device removal and implantation. If the
urethra is healthy, a new cuff can be placed in the same position as the old cuff was removed from; however, if the
urethra is unhealthy, the cuff can be implanted in a more proximal/distal position, or a transcorporal cuff implant may be chosen. This article reviews the literature on diagnostic and treatment strategies for recurrent SUI in male patients with AUS and proposes a flowchart for AUS revision.