Placement of artificial urinary sphincter in children and simultaneous gastrocystoplasty

Purpose: Previous studies have described placement of an artificial urinary sphincter and simultaneous augmentation cystoplasty with a segment of bowe l. Conclusions from these studies indicated that infection rates were highe r and a staged approach should be undertaken. Others have suggested that co ncurrent urinary reconstruction with stomach and sphincter placement can be performed safely. Results comparing infection rates of simultaneous sphinc ter placement and gastrocystoplasty versus staged sphincter placement and a ugmentation cystoplasty using a segment of ileum or stomach versus sphincte r placement alone in a pediatric population have not been previously descri bed to our knowledge. We reviewed these various groups of patients to deter mine if the difference in infectious complications were clinically and stat istically significant. Materials and Methods: A retrospective review of medical records from 1986 to 1999 identified 28 pediatric patients (age 18 years or less) who had und ergone placement of an AS800 dagger artificial urinary sphincter. Data poin ts were collected focusing on etiology of the neurogenic bladder, age at ti me of surgery, types of surgery performed, length of followup and complicat ion rates. Results: Complete data were available for 27 of the 28 patients. Neurogenic bladder was secondary to myelomeningocele in 25 cases, transverse myelitis in 1 and spinal cord injury in 2. Mean patient age at surgery was 12.7 yea rs (range 6.1 to 18.2) and mean followup was 4.3 years (range 1 month to 13 years). Simultaneous gastrocystoplasty was performed in 7 cases (group I), staged sphincter placement followed by augmentation cystoplasty with a seg ment of ileum or stomach was done in 8 (group 2) and 12 did not require bla dder augmentation (group 3). Urethral device erosion requiring explantation was the most common complication, occurring in 3 patients in group 1 and 2 in group 3 (p = 0.101). Mean time to erosion was 22.1 months (range 2 to 4 6.4), Previous surgery (bladder neck or hernia repair) was a common factor in each group with complications. Urine cultures and culture of the explant ed device were positive in 2 patients in group 1. Conclusions: Simultaneous placement of artificial urinary sphincter at the time of gastrocystoplasty can be performed in carefully selected patients, although those undergoing staged procedures did well without complications. Prior bladder neck surgery seems to be a significant risk for infection. A staged approach to lower urinary tract reconstruction would be more advant ageous due to the absence of infection and erosion in those undergoing stag ed sphincter placement and augmentation cystoplasty.