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Experience with AS 800 artificial sphincter in pediatric and young adult patients
D M Barrett1, B G Parulkar, S A Kramer
1Department of Urology, Mayo Clinic, Rochester, Minnesota.
Insights
Artificial sphincter implantation effectively treated urinary incontinence in pediatric and young adult patients. This study found good or fair continence in 94% of patients, highlighting the device
Area of Science:
- Urology
- Pediatric Surgery
- Medical Devices
Background:
- Sphincteric urinary incontinence in children and young adults presents significant physical and social challenges.
- Existing therapeutic options may have limitations, necessitating advanced solutions.
Purpose of the Study:
- To evaluate the efficacy and outcomes of artificial sphincter implantation for treating congenital or acquired sphincteric urinary incontinence.
- To assess the long-term functional results and complications associated with artificial sphincter use in a pediatric and young adult population.
Main Methods:
- A cohort of 59 patients (46 males, 13 females) aged 6-34 years received 61 AS 800 artificial sphincters.
- Mean follow-up was 43 months (range, 5-84 months).
- Twenty-two patients also underwent intestinal cystoplasty for detrusor dysfunction.
Main Results:
- Good continence was achieved in 80% (47/59) of patients, with fair continence in 14% (8/59).
- Overall, 94% of patients experienced good or fair continence.
- Seven percent (4/59) of patients required further intervention, such as sphincter modification or cystoplasty.
Conclusions:
- Artificial sphincter implantation is a viable and effective treatment for pediatric and young adult patients with severe urinary incontinence.
- Careful, prolonged follow-up is crucial to monitor for potential upper urinary tract complications.
- Combined procedures like intestinal cystoplasty may be necessary in select cases to optimize outcomes.
Abstract:
Congenital or acquired sphincteric urinary incontinence in children and young adults is a severe social and physical burden. As a therapeutic option, we implanted 61 AS 800 artificial sphincters in 59 patients (46 males and 13 females). The mean age of the patients was 17.5 years (range, 6 to 34 years), and mean follow-up was forty-three months (range, 5 to 84 months). In addition to artificial sphincter implantation, intestinal cystoplasty was required in 22 patients to obviate problems of increased detrusor contractility or decreased detrusor compliance, or both. Continence was good in 47 patients (80%) and fair in 8 (14%). Four patients (7%) were awaiting sphincter modification or cystoplasty, or both. Careful and prolonged follow-up is mandatory in all patients managed in this fashion to preclude the deleterious effects of subtle changes in detrusor or ureteral function on the integrity of the upper urinary tracts.