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李偉嘉 調查合格的美國泌尿科醫師中,使用男性吊帶手術和人工括約肌手術治療男性應力性尿失禁 2017/5/26 下午 05:22:21 0
原 文 題  目 Male sling and artificial urethral sphincter for male stress urinary incontinence among certifying American urologist
作  者 Liu JS等人。
出  處 Urology 87:95-99, 2016
出版日期 2016
評 論 在國人平均年齡持續增加之下,攝護腺癌與相關之攝護腺根除手術數目,也持續的增加,在這之間不免有術後產生應力性尿失禁。對於攝護腺癌術後產生應力性尿失禁的後續治療,之前以人工括約肌手術為主流,但是這十年來,男性吊帶的手術也漸漸流行起來。本文統計分析泌尿科醫師的行為,發現施行男性吊帶的手術數目已與人工括約肌手術平分秋色。學院派的主流,仍是施行人工括約肌手術。這些手術的執行大部份落於少數熟練技法的醫師之中,經統計這些受過訓練的醫師中,3.4%的醫師們執行22%的手術量,縱使如此,這些醫師每六個月也大多只進行1到2個案例。人工括約肌手術平均來說,需要再次修復的比率約14%是男性吊帶的手術(2.5%)的5.6倍。
abstract

OBJECTIVE:
To examine case volume characteristics among certifying urologists performing male sling and artificial urinary sphincter (AUS) procedures to evaluate practice patterns in male stress urinary incontinence (SUI).

MATERIALS AND METHODS: Six-month case log data of certifying urologists (2003-2013) were obtained from the American Board of Urology. Cases specifying Current Procedural Terminology code for male sling, AUS, and removal or revision of either procedure in males ≥18 years were analyzed.

RESULTS:
Among 1615 urologists (568 certifying and 1047 recertifying) logging at least 1 male incontinence procedure, 2109 (48% of all procedures) male sling and 2284 (52%) AUS cases were identified. The mean age of patients undergoing AUS was 74.9 years and the mean age of patients undergoing sling procedures was 67.3 years (P <.001). An increase in male incontinence procedures from 2003 to 2013 was demonstrated. The rate of male sling procedure increased from 32.7% of incontinence surgeries in 2004 to 45.5% in 2013 (P <.001). Academically affiliated urologists are 1.5 times more likely to perform AUS than male sling for SUI (P <.001). Median number of slings performed was 2 (range 1-40), with 32.7% placing slings exclusively. A small group of certifying urologists (3.4%) accounted for 22% of all male slings placed. This same cohort logged 10.2% of all AUS performed. Surgical management of male SUI varies widely across states (P <.001), with slings performed between 21% and 70% of the time.

CONCLUSION:
Overall the number of male incontinence procedures has increased over time, with a growing proportion of male slings. Most slings and AUS cases are performed by a small number of high- volume surgeons.

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