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Artificial urinary sphincter implantation for neurogenic bladder: a multi-institutional study in 107 children
J Simeoni1, J M Guys, P Mollard
1Department of Paediatric Surgery, La Timone Enfants, Marseille, France.
Insights
The AMS 800 artificial urinary sphincter shows a 77% success rate for treating neurogenic bladder incontinence in children. Careful patient selection and pre-operative assessment are crucial for optimal outcomes with this device.
Area of Science:
- Pediatric Urology
- Biomedical Engineering
- Reconstructive Surgery
Background:
- Neurogenic bladder causes urinary incontinence in children, often due to spina bifida.
- The artificial urinary sphincter (AUS) is a treatment option for refractory incontinence.
- Previous bladder neck surgery can complicate AUS implantation.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the AMS 800 artificial urinary sphincter in pediatric patients with neurogenic bladder.
- To identify factors influencing the success and complications of AUS implantation in children.
Main Methods:
- Retrospective review of 107 children (mean age 13.7 years) who underwent AMS 800 implantation between 1983 and 1993.
- Analysis of patient demographics, underlying conditions (92 with spina bifida), previous surgeries, and follow-up data (mean 61 months).
- Assessment of device survival, revision rates, complications, and continence status.
Main Results:
- The AMS 800 had a mean operational life of 56 months, with a 19% explantation rate.
- Overall success rate was 77%, with 83% of patients with the device in place achieving complete continence.
- Complications included mechanical failures (21), surgical issues (40), and bladder function changes (39).
Conclusions:
- Successful AMS 800 implantation in children requires adequate pre-operative bladder capacity and avoidance of prior bladder neck surgery.
- The bladder neck is the preferred implantation site in pediatric patients.
- Informed consent regarding the high complication rate and need for long-term follow-up is essential.
Objectives:
To evaluate the outcome of implantation of the AMS 800 artificial urinary sphincter in children with neurogenic bladder.
Patients And Methods:
The records of 107 children (74 boys and 33 girls) treated for neurogenic urinary incontinence by implantation of the AMS 800 artificial sphincter between 1983 and 1993 were reviewed retrospectively. The underlying cause of incontinence in 92 patients was spina bifida, the mean age at implantation was 13.7 years and 30 patients had undergone previous bladder neck surgery. Implantation was carried out in combination with another surgical procedure in 24.3% of patients. The mean follow-up was 61 months (minimum 12).
Results:
The mean operational life of the sphincter was 56 months. No deaths occurred but removal of the artificial sphincter was necessary in 20 patients (19%). Surgical revision was not required in 44 patients (41%) but at least one revision was performed in 63 and more than one in 42. There were 21 mechanical failures, 40 surgical complications and 39 cases involving changes in the dynamics of bladder function. Of the 87 children (81%) in whom the device is still in place, 72 are completely continent (83%), 10 are slightly wet, and five are incontinent. The overall success rate was 77%.
Conclusions:
The results emphasize that for successful implantation of an artificial urinary sphincter in children, the pre-operative bladder capacity must be sufficient and previous surgery should not have been performed on the bladder neck, the site of choice for implantation in children. Sphincterotomy is not always necessary in paediatric patients. Children and parents should be informed of the high complication rate and the need for long-term follow-up.