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Updated: Aug 10, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
10-Year experience with artificial urinary sphincter in children and adolescents
R Castera1, M L Podestá, A Ruarte
1Department of Surgery, Urology Unit, Hospital de Niños Ricardo Gutiérrez and Associated Hospital to the University of Buenos Aires, Buenos Aires, Argentina.
Insights
The artificial urinary sphincter (AUS) is effective for pediatric sphincteric incontinence. Prior lower urinary tract surgery significantly increases complication rates with AUS implantation.
Area of Science:
- Pediatric Urology
- Urologic Prosthetics
- Reconstructive Urology
Background:
- Sphincteric incontinence in children and adolescents presents unique management challenges.
- The artificial urinary sphincter (AUS) is a potential therapeutic option for severe cases.
- Understanding specific indications and outcomes is crucial for optimizing patient selection.
Purpose of the Study:
- To evaluate the indications, patient selection criteria, and complication profile of the AMS800 artificial urinary sphincter (AUS) in pediatric and adolescent populations.
- To assess the efficacy of the AUS in achieving continence for sphincteric incontinence in this age group.
Main Methods:
- A retrospective review of 49 pediatric and adolescent patients (mean age 14 years) who underwent AMS800 AUS implantation between 1987 and 1997.
- Etiologies included myelodysplasia, exstrophy-epispadias complex, and urethral trauma.
- Follow-up ranged from 2 to 11 years, assessing continence, complications, and need for clean intermittent catheterization.
Main Results:
- Of 49 patients, 67% achieved continence, and 18% had substantial improvement with the AUS.
- Erosion occurred in 20% of patients, with higher rates associated with prior bladder neck surgery.
- Mechanical failure occurred in 12% of cases; successful revision restored continence in most.
- Clean intermittent catheterization was discontinued in 3 patients post-implantation.
Conclusions:
- The AMS800 artificial urinary sphincter is an effective treatment for pediatric sphincteric incontinence.
- Previous surgical interventions on the lower urinary tract significantly increase the risk of postoperative complications following AUS placement.
- Careful patient selection, considering prior surgical history, is essential for successful AUS outcomes in pediatric patients.
Purpose:
We evaluate specific indications, patient selection and complications of the AMS800 artificial sphincter in children and adolescents with 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 incontinence was myelodysplasia in 38 patients, exstrophy-epispadias complex in 7 and 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 simultaneously in 2 cases. The cuff was adjusted around the bladder neck in 37 patients 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 patients 33 (67%) achieved continence, 9 had substantial improvement and 7 remained unchanged after surgery. Erosion occurred in 10 patients due to sphincter infection in 2, mechanical failure in 6 and postoperative changes in bladder behavior in 2. Of these 10 patients with erosion 5 are incontinent and awaiting sphincter replacement, 2 required bladder neck closure and appendicovesicostomy, and 3 are dry without prosthetic replacement. Mean time to erosion was 24.9 months (range 1 month to 9 years), and 3 erosions occurred within 3 months of sphincter placement. Of the 6 patients with mechanical problems 5 regained continence after successful replacement of the sphincter. Only 2 of the 49 cases had postoperative detrusor overactivity requiring augmentation after surgery. Of the 29 patients who performed clean intermittent 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 patients who had undergone prior bladder neck surgical procedures became continent.
Conclusions:
This study supports previous reports that the artificial urinary sphincter is effective therapy for sphincteric incontinence. Additionally, in our study previous surgical procedures on the lower urinary tract before sphincter placement increased significantly the rate of postoperative complications.
