ARTIFICIAL URINARY SPHINCTER IN THE TREATMENT OF URINARY-INCONTINENCE- PREOPERATIVE URODYNAMICS DO NOT PREDICT THE NEED FOR FUTURE BLADDERAUGMENTATION

Purpose: The artificial urinary sphincter has been used to treat urina ry incontinence in pediatric patients with neurogenic bladders seconda ry to myelodysplasia. Frequently bladder augmentation is performed in conjunction with the artificial urinary sphincter implantation. Identi fying patients with adequate urinary reservoirs who are candidates for implantation without bladder augmentation is a clinical challenge. We reviewed our experience with the artificial urinary sphincter in chil dren with myelodysplasia to determine whether preoperative urodynamic findings predict the need for future augmentation cystoplasty. Materia ls and Methods: We identified 38 patients younger than 18 years at art ificial urinary sphincter implantation who did not undergo augmentatio n enterocystoplasty before or at implantation. We evaluated preoperati ve bladder capacity and compliance to determine whether these standard preoperative urodynamic measurements predict the eventual need for bl adder augmentation in these patients. Results: In the 15 patients who required eventual bladder augmentation after artificial urinary sphinc ter implantation mean bladder capacity plus or minus standard deviatio n was 62.9 +/- 29.9% of age expected capacity and mean bladder complia nce was 8.0 +/- 4.8 ml./cm. water. In the 23 patients who did not requ ire eventual bladder augmentation mean bladder capacity was 59.2 +/- 2 5.4% of age expected capacity and compliance was 7.0 +/- 3.3 ml./cm. w ater. There was no statistically significant difference between the 2 groups. Conclusions: Standard preoperative urodynamics do not predict the patients who undergo isolated artificial urinary sphincter implant ation and eventually require bladder augmentation.