LOWER URINARY-TRACT RECONSTRUCTION USING STOMACH AND THE ARTIFICIAL SPHINCTER

We implanted the artificial urinary sphincter at gastrocystoplasty in 13 male and 5 female patients. The diagnoses were classical bladder ex strophy (8 patients), myelodysplasia (8), cloacal exstrophy (1) and bi lateral ectopic ureters (1). Mean patient age was 14.3 years (range 7 to 32.5). Six patients (5 with bladder exstrophy and 1 with cloacal ex strophy) had failed bladder neck continence procedures, 3 myelodysplas tic patients had failed artificial urinary sphincter placement, and 1 exstrophy patient had failed a Young-Dees bladder neck repair and arti ficial urinary sphincter placement. The sphincter cuff was placed arou nd the reconstructed bladder neck in these patients, while in the rema inder the artificial urinary sphincter was placed around the intact bl adder neck. Mean followup was 20.3 months (range 1 to 5). Of the patie nts 16 (88%) are continent day,and night, while 2 are wet. A total of 11 patients (61%) use Valsalva's maneuver alone for voiding and the re mainder use Valsalva's maneuver and/or clean intermittent catheterizat ion for bladder evacuation. Complications related to the artificial ur inary sphincter were recurrent pump erosion requiring conversion to a Mitrofanoff continent stoma in 1 patient, and mechanical dysfunction r equiring pump cuff and reservoir replacement in 3. There were no compl ications due to infection. Our report demonstrates that the combinatio n of augmentation gastrocystoplasty and an artificial urinary sphincte r leads to urinary continence and can allow for spontaneous urination. The rate of infectious complications is not increased when the 2 proc edures are combined simultaneously.