{"title":"会阴入路与阴囊入路人工尿道括约肌植入术治疗男性压力性尿失禁的比较。","authors":"Waleed Altaweel, Razan Almesned, Raouf Seyam","doi":"10.5144/0256-4947.2023.57","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes.</p><p><strong>Objective: </strong>Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients and methods: </strong>We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively.</p><p><strong>Main outcome measures: </strong>Rates of dry, infection, erosion, malfunction, atrophy, revision.</p><p><strong>Sample size: </strong>44 males who underwent 68 procedures.</p><p><strong>Results: </strong>Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (<i>P</i>=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, <i>P</i>=.042). At the last follow-up, dryness was comparable among groups.</p><p><strong>Conclusion: </strong>The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal.</p><p><strong>Limitations: </strong>Small sample size, single-center.</p><p><strong>Conflict of interest: </strong>None.</p>","PeriodicalId":8016,"journal":{"name":"Annals of Saudi Medicine","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b8/ba/0256-4947.2023.57.PMC9899335.pdf","citationCount":"0","resultStr":"{\"title\":\"A comparison of the perineal and penoscrotal approaches in artificial urinary sphincter implantation for the control of male stress urinary incontinence.\",\"authors\":\"Waleed Altaweel, Razan Almesned, Raouf Seyam\",\"doi\":\"10.5144/0256-4947.2023.57\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes.</p><p><strong>Objective: </strong>Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients and methods: </strong>We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively.</p><p><strong>Main outcome measures: </strong>Rates of dry, infection, erosion, malfunction, atrophy, revision.</p><p><strong>Sample size: </strong>44 males who underwent 68 procedures.</p><p><strong>Results: </strong>Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (<i>P</i>=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, <i>P</i>=.042). At the last follow-up, dryness was comparable among groups.</p><p><strong>Conclusion: </strong>The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal.</p><p><strong>Limitations: </strong>Small sample size, single-center.</p><p><strong>Conflict of interest: </strong>None.</p>\",\"PeriodicalId\":8016,\"journal\":{\"name\":\"Annals of Saudi Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b8/ba/0256-4947.2023.57.PMC9899335.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Saudi Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5144/0256-4947.2023.57\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5144/0256-4947.2023.57","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
A comparison of the perineal and penoscrotal approaches in artificial urinary sphincter implantation for the control of male stress urinary incontinence.
Background: The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes.
Objective: Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach.
Design: Retrospective study.
Setting: Tertiary referral center.
Patients and methods: We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively.
Main outcome measures: Rates of dry, infection, erosion, malfunction, atrophy, revision.
Sample size: 44 males who underwent 68 procedures.
Results: Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (P=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, P=.042). At the last follow-up, dryness was comparable among groups.
Conclusion: The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal.
期刊介绍：
The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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