Ea. Miller et al., SIMULTANEOUS AUGMENTATION CYSTOPLASTY AND ARTIFICIAL URINARY SPHINCTER PLACEMENT - INFECTION-RATES AND VOIDING MECHANISMS, The Journal of urology, 160(3), 1998, pp. 750-752
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.