Silicone shedding from artificial urinary sphincter in children

Silicone is an inert material used in all genitourinary prosthetic devices. Silicone particle shedding has been documented in adults with penile prostheses and artificial urinary sphincters. We searched prospectively for silicone particles in the peri-prosthetic tissue and regional lymph nodes in 6 children who underwent removal or exchange of an artificial urinary sphincter. The peri-prosthetic fibrous capsule was biopsied and examined by light and polarizing microscopy. Regional lymph nodes were biopsied if clinically enlarged and evaluated in a similar manner. Lymph nodes from 2 children without an artificial urinary sphincter served as controls. An artificial urinary sphincter was in place from 3 to 10 years (mean 4.3 years) and none of the sphincters demonstrated infection or erosion. Silicone particles were found in the peri-sphincteric tissue of 3 patients, which induced foreign body giant cell reaction in 2 and eosinophilic infiltrate in 1. Focal histiocytic proliferation around the cuff was seen in another case without silicone migration. There was fibrosis around the sphincter in all cases. No silicone was found in the regional lymph nodes. Silicone shedding was documented in 50% of our patients. X-ray energy dispersive spectroscopy was not performed, raising the possibility that it was under-detected. Long-term effects of silicone in children with an artificial urinary sphincter are unknown and warrant further study.