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[Artificial sphincter in children]
1Université Witten/Herdecke, Urologische Klinik Verbandskrankenhaus.
Insights
Artificial sphincter implantation effectively treats urinary incontinence in children, achieving dryness in 87.2% of cases. The AS 800 model shows improved outcomes and reduced revision rates, offering a superior solution for pediatric urinary control.
Area of Science:
- Pediatric Urology
- Biomedical Engineering
Context:
- Urinary incontinence in children presents significant challenges, impacting renal function and body image.
- Traditional treatments have limitations, necessitating advanced solutions.
Purpose:
- To evaluate the efficacy and safety of artificial sphincter implantation for treating pediatric urinary incontinence.
- To compare outcomes between older models and the recent AS 800 device.
Summary:
- 39 children (4-20 years) received artificial sphincter implants (AS 800 model from 1983).
- 87.2% achieved complete dryness (95.5% with AS 800), with 31 additional procedures for bladder management.
- Complication and revision rates decreased with the AS 800 model due to device improvements and surgical experience.
Impact:
- Artificial sphincter implantation is the most effective treatment for pediatric urinary incontinence.
- Long-term follow-up is crucial to monitor for complications like infection, mechanical failure, and upper tract deterioration.
Abstract:
The ideal treatment of urinary incontinence in children must refer to the subsequent subjects: reestablishment of urinary control, long term conservation of renal function and finally the preservation of normal body image. In this follow up 39 children from 4-20 years have been treated by implantation of an artificial sphincter. From 1983 the recent model AS 800 has been implanted. Because of bladder hyperreflexia and functional or mecanical obstruction 31 further operations had to be done to assure the balanced emptying of a low pressure reservoir with good capacity. After treatment 87.2% of the children (95.5% in the AS 800 group) were totally dry. Because of mecanical (27%) and surgical (33.3%) complications 22 revisions were necessary. With the model AS 800 the revision rate declined to 26%. This is due to the mecanical improvement of the devices and the increasing surgical experience. The results are discussed in relation to alternative treatments of urinary incontinence as supravesical diversion, ureterosigmoidostomy and intermittent catheterization. In conclusion the implantation of an artificial sphincter is the most effective treatment of incontinence in children. The remaining problems as infection and mecanical failure of the delice and the risk of upper tract deterioration because of bladder hyperreflexia ask for a long term follow-up with urodynamic and radiological examinations.