SILICONE SHEDDING FROM ARTIFICIAL URINARY SPHINCTER IN CHILDREN

Silicone is an inert material used in all genitourinary prosthetic dev ices. Silicone particle shedding has been documented in adults with pe nile prostheses and artificial urinary sphincters. We searched prospec tively for silicone particles in the peri-prosthetic tissue and region al lymph nodes in 6 children who underwent removal or exchange of an a rtificial urinary sphincter. The peri-prosthetic fibrous capsule was b iopsied and examined by light and polarizing microscopy. Regional lymp h nodes were biopsied if clinically enlarged and evaluated in a simila r manner. Lymph nodes from 2 children without an artificial urinary sp hincter served as controls. An artificial urinary sphincter was in pla ce from 3 to 10 years (mean 4.3 years) and none of the sphincters demo nstrated infection or erosion. Silicone particles were found in the pe ri-sphincteric tissue of 3 patients, which induced foreign body giant cell reaction in 2 and eosinophilic infiltrate in 1. Focal histiocytic proliferation around the cuff was seen in another case without silico ne migration. There was fibrosis around the sphincter in all cases. No silicone was found in the regional lymph nodes. Silicone shedding was documented in 50% of our patients. X-ray energy dispersive spectrosco py was not performed, raising the possibility that it was under-detect ed. Long-term effects of silicone in children with an artificial urina ry sphincter are unknown and warrant further study.