Compatibility of enterocystoplasty and the artificial urinary sphincter

Placement of the artificial urinary sphincter during augmentation enterocystoplasty may lead to infection, erosion and eventual removal of the device. To assess compatibility of artificial urinary sphincter implantation and enterocystoplasty we reviewed the records of 30 patients who had undergone enterocystoplasty and artificial urinary sphincter placement simultaneously (11), enterocystoplasty before artificial urinary sphincter placement (12) and artificial urinary sphincter placement before enterocystoplasty (7). The 19 male and 11 female patients were between 4 and 42 years old (median age 13.5 years). Followup in 28 patients ranged from 6 months to 8 years (average 17 months). Incontinence resulted from myelodysplasia in 16 patients, sacral agenesis in 3, spinal cord injury in 6, posterior urethral valves in 1, bilateral ectopic ureters in 1 and epispadias-exstrophy in 3. Erosion occurred in 2 patients (7 per cent): 1 female patient who underwent simultaneous sphincter implantation and enterocystoplasty and who had undergone previously many bladder neck reconstructive procedures, including polytetrafluoroethylene (Teflon) injection, and 1 female patient in whom the augmented bladder was entered at artificial urinary sphincter implantation. Mechanical failure occurred 4 times in 3 patients and the artificial urinary sphincter was improperly placed in 1. Over-all continence rate was 87 per cent (26 of 30 patients). Simultaneous placement of the artificial urinary sphincter and enterocystoplasty did not seem to affect the outcome of sphincter implantation if good bowel preparation, intravenous antibiotics and sterility of urine were accomplished preoperatively. Entering the augmented bladder during sphincter implantation may predispose to infection and erosion.