10-YEAR EXPERIENCE WITH THE ARTIFICIAL URINARY SPHINCTER IN CHILDREN

Purpose: To assess the efficacy of the artificial urinary sphincter su rvival and continence were first evaluated 5 years ago. We now evaluat ed the effects of the artificial urinary sphincter more than a decade after implantation. Materials and Methods: Before 1985 an artificial u rinary sphincter was implanted in 22 male and 14 female consecutive pa tients 4 to 30 years old (median age 12). In addition, between 1985 an d 1990, 18 other children underwent artificial urinary sphincter impla ntation. Results of both series were compared. Results: Of the 25 sphi ncters in the original series that were functioning after 5 years 1 wa s removed and 2 patients were lost to followup, resulting in 22 functi oning implants (61% of the patients). Mean survival time of the prosth eses was 12.1 years and average followup for functioning sphincters wa s 13.7 years. There was no statistically significant difference in art ificial urinary sphincter survival between the original group at 5 gea rs and the second group treated after 1985. Of the patients in both gr oups with sphincters in place 32 of 39 (82%) were dry. Augmentation cy stoplasty was performed in 9 of 18 patients (50%) in the second series (5 preoperatively and 4 postoperatively) compared to 10 of 36 (28%) i n the original series at 5 years (3 preoperatively and 7 postoperative ly). Renal failure developed in 6 patients from both series. Conclusio ns: The artificial urinary sphincter is a durable long-term solution f or children with intractable incontinence. Long-term surveillance of t he urinary tract is mandatory because of the potential for renal failu re in patients who have bladder hypertonicity after placement of the d evice.