人工括約肌對於攝護腺手術後尿失禁的治療: 四個醫療機構二十二年的經驗統整

周敬哲、林政鋒、劉冠麟、陳文祥、林承家、陳鴻毅、吳翊豪、楊昀達

基隆長庚紀念醫院 外科部 泌尿科

Artificial urinary sphincters in the treatment of post-prostatectomy incontinence: A summary of 22 years of experience from 4 medical institutions

Ching-Che Chou, Cheng-Feng Lin, Kuan-Lin Liu, Wen-Hsiang Chen, Cheng-Chia Lin, Hung Yi Chen, Yi-Hao Wu, Yun-Ta Yang

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose:  A review of artificial urinary sphincter implantations with AMS-800 in patients with post-prostatectomy incontinence over a course of 22 years.

Materials and methods:  Between 1999 and 2021, 39 patients who had undergone a total of 45 artificial urinary sphincter implantations were retrospectively analyzed.  The patients included met the inclusion criteria for post-prostatectomy incontinence and those with previous rectal surgeries, previous spinal surgeries and those with incontinence period less than 1 year were excluded.   Data was collected over 4 medical institutions in Taiwan with a mean follow up time of 32.8 months.

Results:  The artificial urinary sphincter reached a cure rate (0 pads) of 77.77% and a socially continent rate of 84.44%.  The implantation took a median operation time of 137 minutes, median blood loss 0 – 5 cc and a median of 6 days of hospital admission. Overall complication rate was 40% where 44.44% were due to infections, 38.89% due to mechanical failures, 27.78% due to erosions and 11.11% due to acute urinary retention.  All – cause device failure rate was 37.78% with median device survival time of 81 months.  Survival rate was 72.5% at 1 year, 69.2% at 3 years and 65.3% at 5 years.  Patients with history of transurethral procedures were associated with higher risk of device failure.

Conclusions:  The artificial urinary sphincter is a safe and efficient way of treating patients with post-prostatectomy incontinence.  Patients however need to be informed about the possible complications associated with device implantation, associated risk factors as well as device survival time.