The artificial sphincter (AS-800). Experience in children and young adults

From reviewing our experience in the application of the AS-800 sphincter for the management of incontinence in children, we conclude that implantation is indicated after conservative and less invasive therapy has been attempted. The bladder neck is the site of choice for cuff placement in children. Primary deactivation and moderate or low reservoir pressures (61 to 70 and 71 to 80 cm H2O) are indicated, especially in patients with previous bladder neck surgery or an inadvertent bladder neck injury. Excess residual urine should be evacuated by clean intermittent catheterization. The AS-800 is mechanically reliable (9 mechanical failures in 45 sphincters). When the sphincter is implanted in a select group of patients, upper tract function is maintained in a stable state. Detubularized augmentation cytoplasty must be used to supplement the sphincter in patients with low-compliance, low-capacity, and nonresponsive hyperreflexic bladders. In all patients, long and careful follow-up is necessary to identify late changes in bladder function and consequent upper tract damage. An overall satisfactory result (fair to good) was obtained in 88 per cent of patients during an average follow-up period of 35 months, and 0.6 modifying procedure per patient was done in the sphincters.