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[Artificial urinary sphincter in the treatment of neurogenic bladder in children]
J M Guys1, F Faure, A Chiapello
1Clinique Chirurgicale Infantile et Orthopédie, Hôpital d'Enfants de la Timone, Marseille.
Insights
The AS 800 artificial urinary sphincter achieved 100% continence in 10 children with neurogenic bladder, including those with spina bifida and sacral agenesis. This effective treatment addresses refractory incontinence in pediatric patients.
Area of Science:
- Pediatric Urology
- Biomedical Engineering
- Reconstructive Surgery
Background:
- Neurogenic bladder causes significant incontinence in children, often associated with conditions like spina bifida and sacral agenesis.
- Previous treatments such as medication, intermittent catheterization, and traditional surgeries have often failed to achieve adequate continence.
- Refractory incontinence in pediatric patients necessitates advanced surgical solutions to improve quality of life.
Purpose of the Study:
- To evaluate the efficacy and safety of the AS 800 artificial urinary sphincter in achieving continence in pediatric patients with neurogenic bladder.
- To assess the outcomes of AS 800 implantation in a carefully selected group of children who failed conservative and previous surgical management.
- To highlight the importance of addressing bladder compliance and vesicoureteral reflux concurrently with sphincter implantation.
Main Methods:
- A cohort of 10 children (mean age 14 years) with neurogenic bladder incontinence underwent implantation of the AS 800 artificial urinary sphincter.
- Patients were selected based on failure to respond to pharmaceutical manipulation, intermittent catheterization, or prior reconstructive surgery.
- Sphincters were implanted around the bladder neck, with associated procedures performed in 4 cases to manage comorbidities like vesicoureteral reflux and poor bladder compliance.
Main Results:
- 100% of patients (7 boys, 3 girls) achieved the goal of continence, with a follow-up period ranging from 6 to 32 months (mean 17 months).
- Five patients required intermittent catheterization post-implantation without complications; two patients needed one revision.
- No sphincterotomies were performed, and nocturnal deactivation was utilized in two cases.
Conclusions:
- The AS 800 artificial urinary sphincter is a highly effective solution for achieving continence in children with neurogenic bladder, even in cases of complex etiology and prior treatment failures.
- Rigid patient selection and concurrent management of bladder compliance and vesicoureteral reflux are critical factors for successful outcomes.
- This study demonstrates the AS 800's potential to significantly improve the quality of life for pediatric patients suffering from refractory incontinence due to neurogenic bladder.
Abstract:
Over a two years period, the model AS 800 artificial urinary sphincter was implanted in 10 children (mean 14 years old) with incontinence due to a neurogenic bladder (7 spina bifida; 3 sacral agenesis). Goal of continence was achieved in 100% of 7 boys and 3 girls with a follow up between 6-32 months (mean 17 months). Patients selection was rigid and incontinence have failed to response at pharmaceutic manipulation (6) intermittent catheterisation (5) and previous classical surgery enterocystoplasty (2), Young-Dees procedure (1). Age minimum was 8 years. All sphincters were implanted around the bladder neck. Associated surgical techniques were performed in 4 cases: 2 detubularized enterocystoplasties, 1 Teflon injection for vesico ureteral reflux, 1 closure of previous cystostomy. Sphincterotomy was never done. 5 patients are submitted post implantation to intermittent catheterisation without any problem. 2 patients required one revision. Nocturnal desactivation is used in 2 cases. Authors focus on the necessity of correcting previously or at the time of implantation bladder compliance and vesico ureteral reflux.