SIMULTANEOUS AUGMENTATION CYSTOPLASTY AND ARTIFICIAL URINARY SPHINCTER PLACEMENT - INFECTION-RATES AND VOIDING MECHANISMS

Purpose: Simultaneous augmentation cystoplasty and artificial urinary sphincter placement have recently been reported to be associated with a high incidence of infection. We reviewed our results to define the i nfection rate and outline the mechanisms of voiding in our patient pop ulation. Materials and Methods: A total of 29 patients underwent a sim ultaneous procedure. The etiology of lower urinary tract disease was e xstrophy in 14 patients, myelomeningocele in 10, lipomeningocele in 3, spinal cord injury in 1 and radical retropubic prostatectomy in 1. We used 19 gastric, 5 ileal and 5 colonic intestinal segments. Average f ollowup was 33 months. All patients were followed for a minimum of 2 y ears. Preoperatively all cases had mechanical bowel preparation and do cumented sterile urine cultures or treated bacteriuria. Results: Infec tion developed in 2 patients (6.9%) necessitating artificial urinary s phincter removal at 1 week; and 9 months. There were no infections ass ociated with gastrocystoplasty. Clean intermittent catheterization was required in 21 patients, while the remaining 8 voided spontaneously. Of the 8 patients 4 were catheterized at least once daily to monitor r esidual urine volumes. Of all patients 5 were catheterized with a gast ric tube, 5 with an appendicovesicostomy and 14 per urethra. Conclusio ns: A simultaneous procedure was associated with an acceptable prosthe tic infection rate and gastric segments were associated with the lowes t incidence of infection. The minority of patients voided spontaneousl y. The combination procedure was effective in achieving continence. Ho wever, in the future a nonprosthetic means of providing urethral resis tance may provide better treatment.