10-year experience with artificial urinary sphincter in children and adolescents

Purpose: We evaluate specific indications, patient selection and complicati ons of the AMS800 dagger artificial sphincter in children and adolescents w ith sphincteric incontinence. Materials and Methods: Between 1987 and 1997, 39 males and 10 females with a mean age of 14 years (range 7 to 20) with sphincter deficiency underwent artificial urinary sphincter placement. The underlying etiology of incontin ence was myelodysplasia in 38 patients, exstrophyepispadias complex in 7 an d urethral trauma in 4. All patients underwent preoperatively conventional urodynamic investigations. Augmentation cystoplasty was done in 9 patients before sphincter implantation and both procedures were performed simultaneo usly in 2 cases. The cuff was adjusted around the bladder neck in 37 patien ts and around the bulbar urethra in 12. Followup ranged from 2 to 11 years (mean 7.5). Results: There were 54 sphincter implants in 49 patients. Of the 49 patient s 33 (67%) achieved continence, 9 had substantial improvement and 7 remaine d unchanged after surgery. Erosion occurred in 10 patients due to sphincter infection in 2, mechanical failure in 6 and postoperative changes in bladd er behavior in 2. Of these 10 patients with erosion 5 are incontinent and a waiting sphincter replacement, 2 required bladder neck closure and appendic ovesicostomy, and 3 are dry without prosthetic replacement. Mean time to er osion was 24.9 months (range 1 month to 9 years), and 3 erosions occurred w ithin 3 months of sphincter placement. Of the 6 patients with mechanical pr oblems 5 regained continence after successful replacement of the sphincter. Only 2 of the 49 cases had postoperative detrusor overactivity requiring a ugmentation after surgery. Of the 29 patients who performed clean intermitt ent catheterization preoperatively 3 no longer needed it after implantation of the prosthesis. Finally, 25 (86%) of the 29 patients with a cuff placed around the bladder neck and with no previous surgical repairs at this site achieved continence after implantation whereas only 3 (37.5%) of 8 patient s who had undergone prior bladder neck surgical procedures became continent . Conclusions: This study supports previous reports that the artificial urina ry sphincter is effective therapy for sphincteric incontinence. Additionall y, in our study previous surgical procedures on the lower urinary tract bef ore sphincter placement increased significantly the rate of postoperative c omplications.