Related Experiment Videos
Detrusor instability: a delayed complication in association with the artificial sphincter
Insights
Artificial sphincter implantation in children can lead to bladder issues like high detrusor pressure and incontinence, particularly in those with myelodysplasia. Careful patient selection and monitoring are crucial for successful outcomes.
Area of Science:
- Pediatric Urology
- Neurosurgery
- Reconstructive Surgery
Background:
- Artificial urinary sphincter (AUS) implantation is a surgical procedure used to treat urinary incontinence.
- Complications following AUS implantation can arise, necessitating further investigation and management.
- Understanding the factors contributing to these complications is vital for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence and causes of detrusor dysfunction after artificial sphincter implantation in children.
- To identify risk factors associated with postoperative bladder complications.
- To propose recommendations for improved patient selection and long-term surveillance.
Main Methods:
- Retrospective analysis of 45 children who underwent artificial sphincter implantation.
- Evaluation of urodynamic parameters, including detrusor filling pressure and bladder contractility.
- Review of associated conditions such as myelodysplasia and spinal cord tethering.
Main Results:
- Six out of 45 children (13.3%) experienced elevated detrusor filling pressure and/or uninhibited bladder contractions post-surgery.
- Three children developed hydronephrosis, and three experienced persistent urinary incontinence.
- Myelodysplasia was present in all affected children; spinal cord tethering was noted in three, and three may have had masked detrusor hypertonicity.
Conclusions:
- Post-artificial sphincter implantation detrusor dysfunction is a significant concern, especially in children with myelodysplasia.
- Prompt identification and management of complications like hydronephrosis and incontinence are essential.
- Enhanced preoperative evaluation and postoperative monitoring strategies are recommended to optimize outcomes in this patient population.
Abstract:
Of 45 children with an artificial sphincter 6 had elevated filling pressure of the detrusor and/or uninhibited contractions of the bladder after the implantation surgery, which produced hydronephrosis in 3 and urinary incontinence in 3. All affected individuals had myelodysplasia (17 per cent of this subgroup), 3 had evidence of tethering of the spinal cord and 3 may have had unrecognized detrusor hypertonicity, which was masked by the low outlet resistance before sphincter implantation. Corrective surgery consisted of either decompressive laminectomy with untethering of the spinal cord or augmentation cystoplasty when indicated. Factors affecting the change in the detrusor postoperatively, and recommendations for improved selection and surveillance of individuals undergoing implantation of the artificial device are promulgated.