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The outcome of artificial urinary sphincter placement after a mean 15‐year follow‐up in a paediatric population
Author(s) -
John V. Kryger,
Julia Spencer Barthold,
Patricia A. Fleming,
Ricardo González
Publication year - 1999
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.1999.00077.x
Subject(s) - artificial urinary sphincter , outcome (game theory) , medicine , population , surgery , urinary incontinence , mathematics , environmental health , mathematical economics
Objective To evaluate the long‐term outcome in children who had an artificial urinary sphincter (AUS) placed, after a minimum of 10 years of follow‐up. Patients and methods The medical records of patients who had an AUS placed at the Children’s Hospital of Michigan were reviewed and a telephone questionnaire was then completed by all patients with an AUS currently in place. Results Forty‐seven children initially had an AUS placed between October 1978 and August 1986; medical records and follow‐up were available for 32. After a mean follow‐up of 15.4 years, 13 patients had had the AUS removed and 19 currently have an intact AUS. Erosion or infection was responsible for all AUS removals. Possible risk factors for AUS removal were prior AUS erosion, prior bladder neck surgery and a balloon pressure of >70 cmH 2 O. Eighteen of 19 patients with an intact AUS are dry and seven void volitionally. Revision was the most common reason for additional surgery, but the revision rate has decreased with the most current AS‐800 model, to 0.03 revisions per patient‐year. Of the 13 patients with an AS‐800 model placed after 1987, nine have not required revision. Upper tract changes were mild and uncommon. Conclusion The AUS is a durable and effective surgical option in the management of neurogenic urinary incontinence, and is the only reliable technique that can preserve volitional voiding. With technical improvements to the AUS and a longer follow‐up, the revision rate has decreased. Causes of AUS removal may be preventable with improvements in surgical technique and patient selection. AUS placement should be considered as a first choice for the surgical management of neurogenic sphincteric incompetence.