Premium
Artificial urinary sphincter in patients with neurogenic bladder dysfunction
Author(s) -
Singh G.,
Thomas D.G.
Publication year - 1996
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1996.85515.x
Subject(s) - medicine , sphincter , urinary incontinence , surgery , urology , weakness , perforation , spinal cord injury , neurogenic bladder dysfunction , urination , urinary bladder , urinary system , spinal cord , materials science , punching , psychiatry , metallurgy
Objective To assess the role of the artificial urinary sphincter (AUS) in the management of sphincter weakness incontinence in neuropathic patients. Patients and methods Ninety patients (75 male and 15 female, mean age 26 years, range 13–62) with neurogenic bladder dysfunction (71 with congenital and 19 with acquired cord lesions) who underwent implantation of an AUS were reviewed. All patients were followed up for a minimum of one year after the initial implantation of the sphincter (mean 4 years, range 1–10). Pre‐operative video‐urodynamics demonstrated sphincter weakness incontinence in all patients, with 24 patients having an acontractile‐type bladder. Of 66 patients with intermediate‐type bladders, 52 underwent cystoplasty. Results Eighty‐three patients (92%) were continent both night and day, three were occasionally damp and controlled by pharmacotherapy, and four had a persistent poor result. Of the 66 patients with detrusor hyper‐reflexia, 52 (79%) required a cystoplasty to achieve continence and 14 (21%) were controlled with anti‐cholinergic therapy. The re‐operation rate was 28% (25/90) and complications included six infections, seven erosions, eight system failures, two pump failures, one sheered tube and one rectal and one bladder perforation. Seventy (78%) of the patients currently perform intermittent catheterization to treat high post‐voiding residual urine volumes. Conclusions A rate of continence >90% was achieved in these neurogenic patients after implantation of an AUS and we recommend a simultaneous cystoplasty in patients with detrusor overactivity.