[Urinary incontinence in the neuropathic bladder in children. Treatment using an artificial urinary sphincter]

The neurogenic urinary incontinence can be successfully managed by implantation of an artificial urinary sphincter. The most important requirement for implantation is the recognition that the patient has failed to respond to well-accepted conservative measures or is an unsuitable candidate for such conservative measures. It is necessary to rule out the presence of detrusor hyperreflexia or to show that, if it exists, hyperreflexia can be easily pharmacologically controlled. At the same time the bladder's capability for storage of urine must be "adequate" and the vesical compliance normal or only slightly reduced. The bladder emptying should be unobstructed, without residual urine. The patient must be psychologically motivated and able to utilize the artificial sphincter intelligently. The upper urinary tract should be either normal or stable, preferable with no evidence of vesicorenal reflux. Finally, according to the authors, the patient should be more than 11 years old. In the author's opinion these are the ideal candidates for sphincter implantation. The authors operated on 25 patients with neurogenic urinary incontinence, aged from 13 to 19; 23 were males and 2 females. All the male patient had preoperative transurethral external sphincterotomy. In the first 2 cases we applied model AS 792; both these sphincters were substituted with the last model AS 800. In the other 23 cases model AS 800 was used. The cuff was always placed at the bladder neck and only in 1 case, with a previous operation on the neck, at the urethral bulb. Obviously in this late case, the lower pressure balloon was chosen. In all cases primary deactivation was performed; the sphincter was activated after about 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)