Abstract | PURPOSE: The efficacy of the artificial urinary sphincter to treat sphincteric incontinence in pediatric patients with spina bifida has been clearly reported. The possibility of maintaining spontaneous voiding has usually been the main reason for prosthetic device surgery. We reviewed our experience with the artificial urinary sphincter in patients without spina bifida who had had previous surgery of the bladder neck or proximal urethra. MATERIALS AND METHODS: RESULTS: Only 1 patient was lost to followup. In 22 patients (95.6%) mean followup was 80 months (range 4 to 155). Three sphincters in patients with exstrophy were removed because of erosion and/or infection 5, 49 and 60 months after initial surgery, respectively. A total of 19 sphincters remained in place (86.3% survival rate) with 5 revisions (26.3%) because of the pump (2), the cuff (2) or balloon fluid leakage. In this group 13 patients (68.4%) voided spontaneously and 6 (31.6%) performed clean intermittent catheterization, although 3 also voided spontaneously. Overall continence was good in 87% of patients because 2 were still incontinent at night. CONCLUSIONS: The artificial urinary sphincter is a good long-term solution to urinary incontinence secondary to sphincter incompetence despite multiple previous surgeries of the bladder neck or proximal urethra. Patients with bladder exstrophy and many previous bladder procedures are more exposed to complications such as erosion compared with patients with epispadias or anorectal malformation. The high percent of patients maintaining spontaneous voiding and the good rate of continence are the most important benefits of this type of surgical option for sphincter incompetence.
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Authors | E Ruiz, J Puigdevall, J Moldes, P Lobos, M Boer, J Ithurralde, J Escalante, F de Badiola |
Journal | The Journal of urology
(J Urol)
Vol. 176
Issue 4 Pt 2
Pg. 1821-5
(Oct 2006)
ISSN: 0022-5347 [Print] United States |
PMID | 16945659
(Publication Type: Journal Article)
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Topics |
- Adolescent
- Child
- Child, Preschool
- Female
- Humans
- Male
- Reoperation
- Spinal Dysraphism
(complications)
- Urinary Incontinence
(etiology, surgery)
- Urinary Sphincter, Artificial
(adverse effects)
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