Faculty Collaboration Database

The outcome of artificial urinary sphincter placement after a mean 15-year follow-up in a paediatric population. BJU Int 1999 Jun;83(9):1026-31

Date

06/15/1999

Pubmed ID

10368250

DOI

10.1046/j.1464-410x.1999.00077.x

Scopus ID

2-s2.0-0033012917 (requires institutional sign-in at Scopus site)   60 Citations

Abstract

OBJECTIVE: To evaluate the long-term outcome in children who had an artificial urinary sphincter (AUS) placed, after a minimum of 10 years of follow-up.

PATIENTS AND METHODS: The medical records of patients who had an AUS placed at the Children's Hospital of Michigan were reviewed and a telephone questionnaire was then completed by all patients with an AUS currently in place.

RESULTS: Forty-seven children initially had an AUS placed between October 1978 and August 1986; medical records and follow-up were available for 32. After a mean follow-up of 15.4 years, 13 patients had had the AUS removed and 19 currently have an intact AUS. Erosion or infection was responsible for all AUS removals. Possible risk factors for AUS removal were prior AUS erosion, prior bladder neck surgery and a balloon pressure of >70 cmH2O. Eighteen of 19 patients with an intact AUS are dry and seven void volitionally. Revision was the most common reason for additional surgery, but the revision rate has decreased with the most current AS-800 model, to 0.03 revisions per patient-year. Of the 13 patients with an AS-800 model placed after 1987, nine have not required revision. Upper tract changes were mild and uncommon.

CONCLUSION: The AUS is a durable and effective surgical option in the management of neurogenic urinary incontinence, and is the only reliable technique that can preserve volitional voiding. With technical improvements to the AUS and a longer follow-up, the revision rate has decreased. Causes of AUS removal may be preventable with improvements in surgical technique and patient selection. AUS placement should be considered as a first choice for the surgical management of neurogenic sphincteric incompetence.

Author List

Kryger JV, Spencer Barthold J, Fleming P, González R

Author

John V. Kryger MD Chief, Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Equipment Failure
Female
Follow-Up Studies
Humans
Male
Meningomyelocele
Reoperation
Survival Analysis
Treatment Outcome
Urinary Incontinence
Urinary Sphincter, Artificial
Urinary Tract Infections