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Transcorporal Artificial Urinary Sphincter Cuff Placement in a Case Requiring Revision for Urethral Atrophy
Published on: June 16, 2022
Total continence reconstruction using the artificial urinary sphincter and the Malone antegrade continence enema
Yuval Bar-Yosef1, Miguel Castellan, Devandra Joshi
1Division of Pediatric Urology, Miami Children's Hospital and Department of Urology, University of Miami, Miami, Florida 33133, USA. yuvalbary@hotmail.com
Insights
Total continence reconstruction using artificial urinary sphincter and Malone antegrade continence enema is effective for managing neurogenic bladder and bowel in myelomeningocele patients. This surgical approach achieves durable urinary and fecal continence, significantly improving quality of life.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Myelomeningocele often results in neurogenic bladder and bowel dysfunction, significantly impacting patients' quality of life.
- Effective management strategies are crucial for addressing these complex issues in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of total continence reconstruction using artificial urinary sphincter (AUS) and Malone antegrade continence enema (MACE) in children with myelomeningocele.
- To present the surgical outcomes and complication rates of this combined procedure.
Main Methods:
- Retrospective chart review of 21 myelomeningocele patients undergoing simultaneous AUS placement and MACE between 1997 and 2007.
- AUS cuff placed around the bladder neck; MACE performed using appendix or cecal flaps.
- Concomitant procedures included augmentation cystoplasty and Mitrofanoff vesicostomy in select patients.
Main Results:
- 81% of patients achieved complete urinary continence; 90% achieved fecal continence.
- 16% of patients achieved complete urinary and fecal continence.
- Postoperative complications included ileus and urinary tract infections; MACE stoma stenosis occurred in 3 patients.
Conclusions:
- Simultaneous artificial urinary sphincter and Malone antegrade continence enema offers a viable solution for achieving urinary and fecal continence in myelomeningocele patients.
- The combined procedure demonstrates durable results, significantly improving functional outcomes and quality of life.
Purpose:
Surgical management of children with myelomeningocele addresses 2 aspects of the disease, neurogenic bladder and neurogenic bowel. Results of total continence reconstruction using an artificial urinary sphincter and Malone antegrade continence enema are presented.
Materials And Methods:
We performed a retrospective chart review of patients who underwent simultaneous artificial urinary sphincter placement and a Malone antegrade continence enema procedure. From 1997 to 2007 a total of 21 patients with myelomeningocele underwent total continence reconstruction using the artificial urinary sphincter. Mean patient age was 10.4 years (range 6 to 22) and mean followup was 4.7 years (range 0.66 to 11.7). Artificial urinary sphincter cuff was placed around the bladder neck. A Malone antegrade continence enema was performed using appendix in 19 patients and cecal based flaps in 2. Two patients underwent concomitant augmentation cystoplasty. Six patients had concomitant Mitrofanoff vesicostomy using split appendix in 4 and Monti tube in 2.
Results:
Immediate postoperative complications were observed in 5 patients, including prolonged ileus (2), urinary tract infection (2) and superficial wound dehiscence (1). Seventeen patients (81%) achieved complete urinary continence and 5 were voiding with sphincter cycling. Improvement in urinary continence with dry intervals greater than 3 hours was reported in 2 patients. There were 19 patients (90%) who reported fecal continence, with 2 reporting soiling 1 to 2 times a week. Malone antegrade continence enema stoma stenosis occurred in 3 patients and 2 required revisions. Sixteen patients (76%) achieved complete continence of stool and urine. During followup 2 artificial urinary sphincters were explanted and 8 patients (38%) underwent bladder augmentation.
Conclusions:
Urinary and fecal continence in patients with myelomeningocele is achievable with a single total continence reconstruction procedure using the artificial urinary sphincter and the Malone antegrade continence enema with durable results.
