Combined use of enterocystoplasty and a new type of artificial sphincter in the treatment of urinary incontinence.
OBJECTIVE
We report the results of the combination of enterocystoplasty and a periurethral expander, a simplified type of artificial sphincter, in the treatment of urinary incontinence.


METHODS
The new 1-piece device has an adjustable cuff connected to a port positioned at the subcutaneous space in the abdomen. The cuff is adjusted to the bladder neck and the pins are fixed according to the diameter of the urethra. The port is punctured percutaneously and saline is injected until continence is achieved. Eight boys and 3 girls underwent nonsecretory sigmoid cystoplasty and placement of the device at a single operation. Nine patients had neurogenic bladder and in 2 exstrophy reconstruction had failed. Followup ranged from 4 to 26 months.


RESULTS
All patients were continent with improved bladder compliance 6 to 8 weeks after the operation, when the device was activated. In 1 case the device was extracted after 2 months due to frequent episodes of hematuria and edema at the port site. Two patients had erosion of the skin at the port site. Urodynamics were repeated at the time of activation. Maximal urethral closing pressure increased from 16.27 to 157.44%. Two patients needed a second injection to achieve continence. The patients with exstrophy void spontaneously and those with neurogenic bladder are on clean intermittent catheterization.


CONCLUSIONS
Although more followup is needed, the combination of these procedures seems to offer a new option for the treatment of urinary incontinence in children.
Lima
S V
SV
Section of Urology, Hospital Infantil Manoel Almeida, Recife, Brazil.
Araújo
L A
LA
Vilar
F O
FO
Kummer
C L
CL
Lima
E C
EC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000637:transplantation*; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D016741:Urinary Sphincter, Artificial