Use of the artificial urinary sphincter in spinal cord injury patients

A total of 49 patients with neuropathic bladder dysfunction and urinary incontinence underwent implantation of the AS791/792 artificial urinary sphincter. Preoperative urodynamic evaluation allowed the bladder response to be categorized as hyperreflexia, areflexia and low compliance. The over-all success rate in obtaining total urinary continence in these patients was 70 per cent, although the type of bladder present did influence the degree of success. Although urodynamic evaluation is an essential prerequisite for sphincter implantation there were no clear-cut data that allowed an accurate prediction of the postoperative result. The only absolute contraindication to implantation of the artificial urinary sphincter is significant bladder fibrosis. Owing to the success in obtaining total urinary continence in this complicated group of patients, we believe that the artificial urinary sphincter should be considered in carefully selected patients with neuropathic bladder dysfunction secondary to spinal cord injury.