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10-YEAR EXPERIENCE WITH ARTIFICIAL URINARY SPHINCTER IN CHILDREN AND ADOLESCENTS

2001; Lippincott Williams & Wilkins; Volume: 165; Issue: 6 Part 2 Linguagem: Inglês

10.1016/s0022-5347(05)66207-6

1527-3792

Roberto Castéra, Miguel Luis Podestá, ADOLFO RUARTE, Marcela Herrera, Ricardo Medel,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologySphincter1 Jun 200110-YEAR EXPERIENCE WITH ARTIFICIAL URINARY SPHINCTER IN CHILDREN AND ADOLESCENTS ROBERTO CASTERA, MIGUEL L. PODESTÁ, ADOLFO RUARTE, MARCELA HERRERA, and RICARDO MEDEL ROBERTO CASTERAROBERTO CASTERA More articles by this author , MIGUEL L. PODESTÁMIGUEL L. PODESTÁ More articles by this author , ADOLFO RUARTEADOLFO RUARTE More articles by this author , MARCELA HERRERAMARCELA HERRERA More articles by this author , and RICARDO MEDELRICARDO MEDEL More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66207-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluate specific indications, patient selection and complications of the AMS800† American Medical Systems, Inc., Minnetonka, Minnesota. artificial sphincter in children and adolescents with sphincteric incontinence. Materials and Methods: Between 1987 and 1997, 39 males and 10 females with a mean age of 14 years (range 7 to 20) with sphincter deficiency underwent artificial urinary sphincter placement. The underlying etiology of incontinence was myelodysplasia in 38 patients, exstrophy-epispadias complex in 7 and urethral trauma in 4. All patients underwent preoperatively conventional urodynamic investigations. Augmentation cystoplasty was done in 9 patients before sphincter implantation and both procedures were performed simultaneously in 2 cases. The cuff was adjusted around the bladder neck in 37 patients and around the bulbar urethra in 12. Followup ranged from 2 to 11 years (mean 7.5). Results: There were 54 sphincter implants in 49 patients. Of the 49 patients 33 (67%) achieved continence, 9 had substantial improvement and 7 remained unchanged after surgery. Erosion occurred in 10 patients due to sphincter infection in 2, mechanical failure in 6 and postoperative changes in bladder behavior in 2. Of these 10 patients with erosion 5 are incontinent and awaiting sphincter replacement, 2 required bladder neck closure and appendicovesicostomy, and 3 are dry without prosthetic replacement. Mean time to erosion was 24.9 months (range 1 month to 9 years), and 3 erosions occurred within 3 months of sphincter placement. Of the 6 patients with mechanical problems 5 regained continence after successful replacement of the sphincter. Only 2 of the 49 cases had postoperative detrusor overactivity requiring augmentation after surgery. Of the 29 patients who performed clean intermittent catheterization preoperatively 3 no longer needed it after implantation of the prosthesis. Finally, 25 (86%) of the 29 patients with a cuff placed around the bladder neck and with no previous surgical repairs at this site achieved continence after implantation whereas only 3 (37.5%) of 8 patients who had undergone prior bladder neck surgical procedures became continent. Conclusions: This study supports previous reports that the artificial urinary sphincter is effective therapy for sphincteric incontinence. Additionally, in our study previous surgical procedures on the lower urinary tract before sphincter placement increased significantly the rate of postoperative complications. References 1 : The importance of a successful initial bladder closure in the surgical management of classical bladder exstrophy: analysis of 144 patients treated at The John Hopkins Hospital between 1975 and 1985. J Urol1987; 137: 258. Link, Google Scholar 2 : Surgical correction of total urinary incontinence. J Urol1964; 91: 261. 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Nijman R (2001) Neurogenic and non-neurogenic bladder dysfunctionCurrent Opinion in Urology, 10.1097/00042307-200111000-00004, VOL. 11, NO. 6, (577-583), Online publication date: 1-Nov-2001. Volume 165Issue 6 Part 2June 2001Page: 2373-2376 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsurinary incontinenceurodynamicsurinary sphincter, artificialMetrics Author Information ROBERTO CASTERA More articles by this author MIGUEL L. PODESTÁ More articles by this author ADOLFO RUARTE More articles by this author MARCELA HERRERA More articles by this author RICARDO MEDEL More articles by this author Expand All Advertisement PDF downloadLoading ...