UPSIZING OF THE ARTIFICIAL URINARY SPHINCTER CUFF TO FACILITATE SPONTANEOUS VOIDING

Objectives. Following placement of an artificial urinary sphincter (AU S) in the male child, functional and mechanical alterations can ensue, resulting in an inability to void spontaneously. One possible mechani cal etiology in the patient entering puberty is prostatic growth withi n the fixed mechanical confines of the AUS cuff, resulting in progress ive bladder outlet obstruction. Unrecognized infravesical obstruction can, in turn, lead to upper urinary tract deterioration, sepsis, or re nal failure. We evaluated the effect of somatic growth and maturation of the male urethra on voiding dynamics in boys with an AUS to specifi cally determine whether revision of the sphincter cuff (ie, upsizing) is beneficial in restoring the ability to void spontaneously. Methods. A retrospective review of 124 children with an AUS was performed. Ele ven boys were identified whose bladder neck cuffs were later upsized i n an attempt to improve bladder emptying. All boys were prepubertal at the time of original cuff placement. The average interval between the initial operation and cuff upsizing was 5 years. Results. Following o riginal sphincter placement, 8 patients emptied to completion spontane ously and 3 patients emptied by intermittent catheterization. Ail eigh t of the spontaneous voiders experienced progressive difficulty emptyi ng after they entered puberty and ultimately had to rely on clean inte rmittent catheterization to empty completely. Follow-up subsequent to cuff exchange averaged more than 5 years (range 1 to 10 years). Despit e an average increase of 10 mm in cuff size, all patients continued to depend on intermittent catheterization to empty completely. Conclusio ns. Upsizing the bladder cuff in the maturing male who experiences dif ficulty with bladder emptying does not restore the ability to void spo ntaneously. (C) 1997, Elsevier Science Inc. All rights reserved.