Abstract
Introduction. Stress urinary incontinence in men in most cases occurs after radical prostatectomy or surgery of benign prostate hyperplasia. In addition to a significant reduction in the quality of life, the treatment and care of such patients require significant financial costs. Purpose of the study . To study the long-term efficacy and safety of artificial urinary sphincter (AUS) implantation. Materials and methods . AUS was implanted in 52 patients with severe stress urinary incontinence (UI) from 2004 to 2020. Urine loss was estimated by the urinary diary. A cure was considered as the use of ≤ 1 pad per day («social continence»). The quality of life was assessed using a numeric scale (from 0 to 100), IPSS-QoL, and the ICIQ-UI SF questionnaire. Complications were described according to the Clavien-Dindo classification. Results. The median age was 67.5 years (IQR 63 - 72 years). The causes of severe stress UI were the following: radical prostatectomy - 29 (55.8%) patients, transurethral resection of the prostate — 12 (23.1%), transvesical simple prostatectomy — 5 (9.6%), others — 6 (11.5%) patients. Median time after the intervention that caused UI was 24 months (IQR 13-36 months). Both perineal (67%) and penoscrotal (33%) approaches were used. The results of implantation efficiency were evaluated in 43 patients. A significant decrease in the median urine loss from 800 ml (IQR 700 - 1100 ml) to 0 ml (IQR 0-30 ml) was registered at a median follow-up of 100.4 months (IQR 70.5 - 136.9 months). There was also a statistically significant reduction in daily pad use from 7 (IQR 6-8) to 1 (IQR 0 - 1). 36 (84%) patients met the cure criteria. Improvement was noted in 6 (14%) patients, failure - in 1 (2%) patient. Median IPSS-QoL scores decreased from 4 (IQR 4-5) to 2 (IQR 1 - 2), p < 0.05, numeric analog scale scores improved from 25 (IQR 20 - 35) to 80 (IQR 60 - 90), p < 0.05., The ICIQ-UI SF score was 7 (IQR 1-9) after treatment. Complications more than grade II according to the Clavien-Dindo classification were registered in 15 (28.8%) patients. Conclusion. AUS implantation provides satisfactory results in reducing urine loss and improving quality of life but it's accompanied by a high rate of complications and revisions in long-term follow-up.
Highlights
Stress urinary incontinence in men in most cases occurs after radical prostatectomy or surgery of benign prostate hyperplasia
artificial urinary sphincter (AUS) was implanted in 52 patients with severe stress urinary incontinence (UI) from 2004 to 2020
Urine loss was estimated by the urinary diary
Summary
Изучение эффективности и безопасности имплантации искусственного мочевого сфинктера (ИМС) при долгосрочном наблюдении. С 2004 по 2020 год ИМС имплантирован 52 пациентам со стрессовым недержанием мочи (НМ) тяжелой степени. Качество жизни оценено с помощью цифровой шкалы (от 0 до 100), IPSS QoL и опросника ICIQ-UI SF. Послужившего причиной НМ, составила 24 месяца (IQR 13 – 36 месяцев). При медиане наблюдения 100,4 месяцев (IQR 70,5 – 136,9 месяцев) отмечено статистически значимое снижение медианы потерь мочи с 800 ml (IQR 700 – 1100 ml) до 0 ml (IQR 0 – 30 ml). Осложнения более II степени согласно классификации Clavien-Dindo отмечены у 15 (28,8%) пациентов. При долгосрочном наблюдении имплантация ИМС обеспечивает удовлетворительные результаты в отношении сокращения потерь мочи и улучшения качества жизни, но сопровождается высокой частотой осложнений и ревизий. Long-term efficacy and safety of artificial urinary sphincter AMS 800ТМ implantations
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