Artificial urinary sphincter in the treatment of urinary incontinence: preoperative urodynamics do not predict the need for future bladder augmentation.
OBJECTIVE
The artificial urinary sphincter has been used to treat urinary incontinence in pediatric patients with neurogenic bladders secondary to myelodysplasia. Frequently bladder augmentation is performed in conjunction with the artificial urinary sphincter implantation. Identifying patients with adequate urinary reservoirs who are candidates for implantation without bladder augmentation is a clinical challenge. We reviewed our experience with the artificial urinary sphincter in children with myelodysplasia to determine whether preoperative urodynamic findings predict the need for future augmentation cystoplasty.


METHODS
We identified 38 patients younger than 18 years at artificial urinary sphincter implantation who did not undergo augmentation enterocystoplasty before or at implantation. We evaluated preoperative bladder capacity and compliance to determine whether these standard preoperative urodynamic measurements predict the eventual need for bladder augmentation in these patients.


RESULTS
In the 15 patients who required eventual bladder augmentation after artificial urinary sphincter implantation mean bladder capacity plus or minus standard deviation was 62.9+/-29.9% of age expected capacity and mean bladder compliance was 8.0+/-4.8 ml./cm. water. In the 23 patients who did not require eventual bladder augmentation mean bladder capacity was 59.2+/-25.4% of age expected capacity and compliance was 7.0+/-3.3 ml./cm. water. There was no statistically significant difference between the 2 groups.


CONCLUSIONS
Standard preoperative urodynamics do not predict the patients who undergo isolated artificial urinary sphincter implantation and eventually require bladder augmentation.
Department of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, USA.
K M
KM
Kronner
R C
RC
Rink
G
G
Simmons
B P
BP
Kropp
A J
AJ
Casale
M P
MP
Cain
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009436:Neural Tube Defects / Q000150:complications; D011237:Predictive Value of Tests; D011300:Preoperative Care; D001743:Urinary Bladder / Q000601:surgery; D014549:Urinary Incontinence / Q000503:physiopathology* / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics