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Artificial urinary sphincter in children--voiding or emptying? An evaluation of functional results in 44 patients

M Catti1, S Lortat-Jacob, M Morineau

  • 1Service de Chirurgie Infantile, Professor Yann Revillon, Hôpital Necker-Enfants Malades, Paris, France. massimocatti@libero.it

The Journal of Urology
|June 17, 2008
PubMed

Insights

The artificial urinary sphincter (AUS) offers good continence for pediatric patients but has frequent complications, leading to removal in 20%. Many patients require clean intermittent catheterization for bladder emptying post-implantation.

Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Urology

Background:

  • Urinary incontinence in children and adolescents often necessitates advanced treatment options.
  • The artificial urinary sphincter (AUS) is a device used to manage severe urinary incontinence.

Purpose of the Study:

  • To evaluate the functional outcomes of artificial urinary sphincter implantation in pediatric and adolescent patients.
  • Assessing complications, continence rates, and voiding abilities following AUS implantation.

Main Methods:

  • A cohort of 44 pediatric and adolescent patients (median age 14) received a pericervical AMS 800 artificial urinary sphincter.
  • Patients had a median follow-up of 5.5 years, with some having undergone prior or concurrent augmentation cystoplasty.
  • Complications included dysuria, retention, bladder dysfunction, erosions, mechanical failures, and infections, leading to device removals, deactivations, revisions, and replacements.

Main Results:

  • After AUS removal, 20% of patients remained incontinent.
  • Among patients with the AUS in place, 73% achieved dryness, while 7% remained incontinent with a deactivated device.
  • Spontaneous voiding to completion was achieved by 48.6% of patients; 25.7% required post-void catheterization, and 25.7% relied solely on clean intermittent catheterization (CIC).
  • Implantation before puberty or with an augmented bladder significantly decreased the ability to void spontaneously.

Conclusions:

  • The artificial urinary sphincter demonstrates efficacy in achieving urinary continence in pediatric and adolescent populations.
  • Frequent complications necessitate device intervention in a significant percentage of cases, with 20% requiring removal.
  • Long-term bladder emptying without clean intermittent catheterization is limited for many patients.
Abstract

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