LONG-TERM RESULTS OF THE ARTIFICIAL URINARY SPHINCTER IN MALE-PATIENTS WITH NEUROGENIC BLADDER

The records of patients who received an artificial urinary sphincter a t the University of Minnesota were reviewed. A total of 19 patients fu lfilled the following criteria: male gender, neurogenic sphincteric in competence, no previous surgery on the bladder neck, myelodysplasia an d more than 5 years of followup. Mean age at the time of implantation was 8 years, mean age at the last followup was 16.5 years and mean fol lowup was 8 years. At the last followup 16 patients (84.2%) were conti nent and 3 were expected to regain continence after revision or bladde r augmentation. At the last followup 78.9% of the patients were on ant icholinergic medications and 73.8% voided by clean intermittent cathet er ization. A fourth of the patients voided spontaneously. The annual revision rate was 0.2 revisions per patient. Seven patients (36.8%) ha ve undergone or will require bladder augmentation. Upper tract dilatat ion developed in 2 patients and the function of 1 of 38 renal units at risk was lost. We conclude that the artificial urinary sphincter is a n excellent modality for the initial surgical treatment of neurogenic sphincteric incompetence in male patients. Careful patient selection a nd lifelong surveillance are essential to success and safety.