14 years of experience with the artificial urinary sphincter in children and adolescents without spina bifida
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Updated: Jul 20, 2026
Transcorporal Artificial Urinary Sphincter Cuff Placement in a Case Requiring Revision for Urethral Atrophy
Published on: June 16, 2022
E Ruiz1, J Puigdevall, J Moldes
1Section of Pediatric Surgery and Pediatric Urology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
The artificial urinary sphincter effectively treats urinary incontinence in pediatric patients without spina bifida, with a high success rate for spontaneous voiding and continence. This prosthetic device offers a good long-term solution for complex cases.
Area of Science:
- Urology
- Pediatric Surgery
- Medical Devices
Background:
- Artificial urinary sphincter (AUS) efficacy is established for spina bifida-related incontinence.
- Spontaneous voiding is a key goal for prosthetic device surgery.
- This study evaluates AUS in non-spina bifida pediatric patients with prior bladder neck or urethral surgery.
Purpose of the Study:
- To assess the long-term efficacy and outcomes of the AMS 800 artificial urinary sphincter in pediatric patients without spina bifida who have undergone previous bladder neck or proximal urethral surgery.
- To identify potential complications and success rates in this specific patient cohort.
Main Methods:
- A retrospective review of 112 pediatric patients who received an AMS 800 AUS between 1990 and 2004.
- Focus on a subgroup of 23 patients (19 males, 4 females) aged 4-17 years without spina bifida, including those with bladder exstrophy, anorectal malformation with fistula, or epispadias.
- Utilized a bladder neck cuff (5.5-7.5 cm) and a 61-70 balloon for all patients.
Main Results:
- Follow-up in 22 patients (95.6%) averaged 80 months (range 4-155).
- Sphincter survival rate was 86.3% (19/22), with 5 revisions due to device issues (pump, cuff, balloon leakage).
- Continence was achieved in 87% of patients, with 68.4% maintaining spontaneous voiding and 31.6% requiring clean intermittent catheterization.
Conclusions:
- The artificial urinary sphincter is a viable long-term solution for urinary incontinence in pediatric patients with complex conditions and prior surgeries.
- Patients with bladder exstrophy and multiple prior procedures face higher risks of complications like erosion.
- High rates of spontaneous voiding and continence underscore the benefits of AUS for sphincter incompetence.
Purpose:
The efficacy of the artificial urinary sphincter to treat sphincteric incontinence in pediatric patients with spina bifida has been clearly reported. The possibility of maintaining spontaneous voiding has usually been the main reason for prosthetic device surgery. We reviewed our experience with the artificial urinary sphincter in patients without spina bifida who had had previous surgery of the bladder neck or proximal urethra.
Materials And Methods:
From 1990 to 2004, 112 children and adolescents underwent implantation of an AMS 800 artificial urinary sphincter. Of the patients 19 males and 4 females (20.5%) between ages 4 and 17 years (mean 8.1) had no spina bifida. Instead there were bladder exstrophy in 12 patients, anorectal malformation with a rectourethral or vesical fistula in 7 and epispadias in 4. A bladder neck cuff between 5.5 and 7.5 cm, and a 61-70 balloon were used in all patients.
Results:
Only 1 patient was lost to followup. In 22 patients (95.6%) mean followup was 80 months (range 4 to 155). Three sphincters in patients with exstrophy were removed because of erosion and/or infection 5, 49 and 60 months after initial surgery, respectively. A total of 19 sphincters remained in place (86.3% survival rate) with 5 revisions (26.3%) because of the pump (2), the cuff (2) or balloon fluid leakage. In this group 13 patients (68.4%) voided spontaneously and 6 (31.6%) performed clean intermittent catheterization, although 3 also voided spontaneously. Overall continence was good in 87% of patients because 2 were still incontinent at night.
Conclusions:
The artificial urinary sphincter is a good long-term solution to urinary incontinence secondary to sphincter incompetence despite multiple previous surgeries of the bladder neck or proximal urethra. Patients with bladder exstrophy and many previous bladder procedures are more exposed to complications such as erosion compared with patients with epispadias or anorectal malformation. The high percent of patients maintaining spontaneous voiding and the good rate of continence are the most important benefits of this type of surgical option for sphincter incompetence.
