[Artificial sphincter in children].
The ideal treatment of urinary incontinence in children must refer to the subsequent subjects: reestablishment of urinary control, long term conservation of renal function and finally the preservation of normal body image. In this follow up 39 children from 4-20 years have been treated by implantation of an artificial sphincter. From 1983 the recent model AS 800 has been implanted. Because of bladder hyperreflexia and functional or mecanical obstruction 31 further operations had to be done to assure the balanced emptying of a low pressure reservoir with good capacity. After treatment 87.2% of the children (95.5% in the AS 800 group) were totally dry. Because of mecanical (27%) and surgical (33.3%) complications 22 revisions were necessary. With the model AS 800 the revision rate declined to 26%. This is due to the mecanical improvement of the devices and the increasing surgical experience. The results are discussed in relation to alternative treatments of urinary incontinence as supravesical diversion, ureterosigmoidostomy and intermittent catheterization. In conclusion the implantation of an artificial sphincter is the most effective treatment of incontinence in children. The remaining problems as infection and mecanical failure of the delice and the risk of upper tract deterioration because of bladder hyperreflexia ask for a long term follow-up with urodynamic and radiological examinations.
Grein
U
U
Université Witten/Herdecke, Urologische Klinik Verbandskrankenhaus.
Schreiter
F
F
D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012086:Reoperation; D014546:Urinary Catheterization; D014547:Urinary Diversion; D014549:Urinary Incontinence / Q000601:surgery*
Le sphincter artificiel chez l'enfant.