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The long-term results of artificial sphincters in children
P J Bosco1, S B Bauer, A H Colodny
1Division of Urology, Children's Hospital, Boston, Massachusetts.
Insights
The artificial urinary sphincter (AUS) shows long-term efficacy in children with intractable incontinence. While complications like fluid leakage occur, the AUS offers a viable treatment option, with success rates improving with newer models.
Area of Science:
- Pediatric Urology
- Biomedical Engineering
- Surgical Devices
Background:
- Intractable urinary incontinence in children poses significant management challenges.
- Previous treatments may be ineffective or unsuitable for certain pediatric patients.
- The artificial urinary sphincter (AUS) is a prosthetic device designed to restore urinary continence.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of the artificial urinary sphincter (AUS) in pediatric patients.
- To identify factors influencing the success and complication rates of AUS implantation.
- To assess the durability and survival time of the AUS prosthesis in children.
Main Methods:
- A retrospective study of 36 children who received an AUS between 1978 and 1985.
- Minimum follow-up of 5 years, with re-evaluation within 3 months of the study.
- Analysis of device survival, complication rates, revision rates, and patient continence levels.
Main Results:
- 75% of implanted AUS devices were still in place at follow-up.
- The overall success rate was 84% at 2 years and 62% at 5 years.
- Fluid leakage was the most common complication (12 patients), necessitating reoperation. Higher balloon pressures correlated with more complications and lower success rates.
Conclusions:
- The artificial urinary sphincter (AUS) is a viable long-term treatment for intractable pediatric incontinence.
- Device survival and patient continence can be achieved, though complications require management.
- Improvements in AUS models (post-1980) demonstrated a lower reoperation rate, suggesting technological advancements enhance efficacy.
Abstract:
To determine the long-term efficacy of the artificial urinary sphincter, 36 consecutive children in whom a prosthesis was implanted between August 1978 and July 1985 were followed for a minimum of 5 years and re-evaluated within the last 3 months. Of the 36 sphincters 27 (75%) are currently in place; 2 of these 27 sphincters are dysfunctional due to fluid leakage. Of the 25 functioning sphincters 14 have required no further prosthetic operation, 10 needed 1 revision and 1 patient had 5 revisions. Fluid leakage, occurring in 12 patients, was the most common complication requiring reoperation. Twenty patients are completely continent (11 of whom without any medication) and 5 are occasionally damp. The over-all success rate at 2 and 5 years was 84 and 62%, respectively. The mean survival time of the prosthesis was 7.2 years and the mean standard interval was greater than 10.5 years. Patients with higher balloon pressures (81 to 100 cm. water) had more complications, and a decreased rate of success than those with lower pressure balloons (51 to 80 cm. water, p = 0.02). There was no difference in success rates between boys and girls (p = 0.98), although girls who had a prior bladder neck operation tended to have a higher rate of cuff erosion. Sphincters placed after 1980 (model AS800) had a lower reoperation rate than those placed earlier. In selected instances, the artificial urinary sphincter appears to be a viable long-term alternative for management of children with intractable incontinence who have either failed or are unsuitable for other methods of treatment.