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Urinary tract deterioration associated with the artificial urinary sphincter
Insights
Artificial sphincter implantation in children shows high continence rates but requires lifelong monitoring. Long-term follow-up revealed potential bladder and upper tract complications, necessitating ongoing urodynamic and radiological assessments.
Area of Science:
- Pediatric Urology
- Urological Devices
Background:
- Artificial sphincter implantation has improved outcomes for urinary incontinence.
- Recent series report reduced complications and high continence rates nearing 90%.
Purpose of the Study:
- To evaluate long-term outcomes of artificial sphincter implantation in pediatric patients.
- To identify potential delayed complications beyond initial follow-up.
Main Methods:
- Retrospective analysis of 47 pediatric patients with artificial sphincter implants.
- In-depth radiological and urodynamic evaluations preoperatively and during follow-up.
Main Results:
- Initially excellent results were observed in all patients.
- Transient hydronephrosis occurred in 5 children due to incomplete bladder emptying.
- Persistent rigid, noncompliant bladder dynamics were noted in 7 children.
- Complications arose despite thorough preoperative assessments and suitability for the device.
Conclusions:
- Artificial sphincters can lead to delayed bladder and upper tract deterioration, even without urinary leakage.
- Indefinite, lifelong monitoring is crucial for children with artificial sphincters.
- Semiannual upper tract assessment and periodic urodynamic evaluations are recommended.
Abstract:
In most recent series of artificial sphincter implantations there has been a reduction in mechanical and surgical complications, with continence rates approaching 90 per cent. Despite initially excellent results in 47 children, with increasing durations of followup we noted a transient hydronephrosis related to incomplete bladder emptying in 5 and a persistent physiological alteration of detrusor dynamics consisting of a rigid, noncompliant bladder in 7. Preoperatively, all patients had had indepth radiological studies and most had a urodynamic evaluation, and were considered to be excellent candidates. The etiology of these alterations is not understood at this time. Bladder and even upper tract deterioration can occur without the appearance of urinary leakage. Therefore, children with an artificial sphincter must be monitored indefinitely with semiannual assessment of the upper tracts and periodic urodynamic evaluation.