Experience with the AS-800 artificial urinary sphincter in myelodysplastic children

The authors describe their experience with an artificial urinary sphincter (model AS-800; American Medical Systems, Minnetonka, Minn.) in treating urinary incontinence in children. Twenty-eight sphincters were implanted in 27 boys between May 1986 and June 1989. All the boys had neurogenic bladders secondary to myelomeningocele or sacral agenesis. The mean age at the time of initial implantation was 14 years (range from 9 to 19 years), and the median follow-up was 12 months (range from 6 to 31 months). The sphincters were implanted initially around the bladder neck in 25 cases. Three required reimplantation around the bulbous urethra. The complication rate was 39% (11 of 28 cases). There were two cases of erosion, two cases of infection without erosion and seven cases of device-related problems. The artificial sphincter had to be removed in four cases. There were no deaths. The revision rate was 25% (7 of 28 cases). Continence was evaluated in 22 (88%) of 25 boys who had functional sphincters in place. Five boys required oxybutinin chloride to maintain continence. Ten boys required augmentation cystoplasty before (3), after (6) and combined with (1) sphincter implantation. Eight of these 10 children were able to void spontaneously and were continent. One required intermittent catheterization twice a day and another six times a day. The authors conclude from their experience that the artificial urinary sphincter (model AS-800) can establish continence in boys with neurogenic bladders. Proper selection of the ideal patient for the artificial sphincter is essential to avoid complications.