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發表人 | 討論主題 | 發表時間 | 討論數 |
王炯珵 | 對於男性嚴重應力性尿失禁病患,使用單一人工尿道括約肌在低風險族群和雙重人工尿道括約肌在高風險族群治療成效的比較 | 2016/4/28 下午 09:53:41 | 0 |
原 文 | 題 目 | Outcomes of single versus double cuff artificial urinary sphincter ion in low and high risk profile male patients with severe stress urinary incontinence. |
作 者 | Sascha A. Ahyai, Tim A. Ludwig, Roland Dahlem, Armin Soave, Clemens Rosenbaum, Felix K-H. Chun, Margit Fisch, Marianne Schmid, Luis A.Kluth. | |
出 處 | BJU International. | |
出版日期 | 2016 | |
評 論 |
本研究是來自於德國的漢堡大學醫院,在2009年至2013年之間,總共收了180位男性病患,他們根據病人的病情嚴重度分為兩組,如果病人過去曾經做放射線治療、尿道接受過手術和曾經接受過應力性尿失禁手術者,認為是高危險族群,這些病人接受雙重人工尿道括約肌的置入。如果沒有以上的情況,則接受傳統單一人工尿道括約肌的植入。 結果顯示,在平均24個月的追蹤,這兩組在於每天尿布的使用和客觀尿失禁的分數並沒有差異。但是在主觀的尿失禁方面,雙重人工尿道括約肌組有比較好的分數,平均而言,大概有12.8%的病人有感染、機械性故障和裝置侵蝕的現象,但是雙重人工尿道括約肌組的病人多了5.7倍的長期故障率。 所以結論就是,在比較高危險的族群裝置雙重人工尿道括約肌,和在低危險的族群裝置單一人工尿道括約肌的病人,有相同主觀上的療效。 老實說,對筆者而言,並沒有雙重人工尿道括約肌的手術經驗,不過根據論文中所寫,他主要是放在比較遠端的球部尿道(bulbar urethra),除了費用比較貴之外,因為是放在病人坐的位置的附近,所以也會比較痛。至於效果比較好,是很容易理解的,因為有兩層保險總比一層保險來得好。當然效果最好的地方,是放在膜狀尿道(membranous urethra)的地方,因為當腹壓增加時,這個位置是最容易將壓力傳到尿道的地方,所以可以達到最佳的禁尿效果,同時,病人坐的時候也不會不舒服。 雖然,人工尿道括約肌是目前治療男性應力性尿失禁的黃金治療準則,但也遭受到男性尿道吊帶的挑戰。男性尿道吊帶的最大優點是不用每次尿尿的時候就要去操作這個機關,可以讓病人的生活品質改善。但是男性尿道吊帶的長期療效和安全性,目前的報告還算短,未來這兩種產品可能在市場上都會有很競爭的PK比較。 |
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abstract |
Abstract OBJECTIVES: To evaluate continence and complication rates of bulbar single and distal bulbar double cuff ion according to low and high risk for unfavorable artificial urinary sphincter outcomes. PATIENTS AND METHODS: 180 patients who underwent artificial urinary sphincter implantation between 2009 and 2013 were followed according to institutional standards. Patients with previous pelvic radiation therapy, open bulbar urethral or incontinence surgery ("high risk") underwent distal bulbar double cuff (n=123), all others ("low risk") proximal bulbar single cuff (n=57) placement. Primary and secondary endpoints consisted of continence and complication rates. Kaplan-Meier analysis determined explantation-free survival, Cox regression models assessed risk factors for persistent incontinence and explantation. RESULTS: Median follow-up was 24 months. Whereas no significant difference in pad usage/objective continence was observed after single vs. double cuff ion, superior rates of subjective/social continence and less persistent incontinence were reported by double cuff patients (all p≤0.02). Overall, device explantation (erosion, infection or mechanical failure) occured in 12.8%. While early (<6 weeks) complication rates compared to single cuff were similar (p>0.05), double cuff patients had a 5.7-fold higher risk of device explantation in the late follow-up (p=0.02) and significantly shorter explantation-free-suvival (log-rank: 0.003). CONCLUSIONS: Distal bulbar double cuff ion in patients with a "high risk" profile (previous pelvic radiation, urtehral surgery) leads to similar objective continence, but increased explantation rates when compared to "low risk" proximal bulbar single cuff. Randomized controlled trials comparing both devices will need to differ if higher explanations rates attribute to the double cuff device or risk factors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved. |
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