Is an artificial sphincter the best choice for incontinent boys with Spina Bifida? Review of our long term experience with the AS-800 artificial sphincter.
OBJECTIVE
We describe our long-term experience in a uniform population of Spina Bifida boys all treated with the AS-800 model artificial urinary sphincter (AUS) and compare our results to other treatment modalities available to children with neurogenic incontinence.


METHODS
The complete medical records of 30 patients with insertion of the AS-800 were reviewed. All were boys having Spina Bifida with only one having prior bladder neck reconstruction. The mean age at insertion was 12.6 years and the average follow up was 6.5 years. Anticholinergic agents and self-intermittent catheterization were used concomitantly to the AUS in 21 and 22 patients respectively.


RESULTS
In our series, 19 (63%) patients were completely dry, 6 (20%) were slightly wet, 5 (17%) were incontinent. The mean lifetime of all artificial sphincters was 4.7 years with no statistically significant difference in survival of those inserted at the bladder neck and bulbar urethra (4.6 and 4.9 years respectively). However, a survival analysis revealed a sharp drop after 100 months with only 8.3% of the sphincters implanted lasting beyond this point. There were a total of 32 revisions performed in 17 patients constituting a 0.164 revision rate/patient-years. The other surgical treatment available to these children is bladder neck reconstruction with reported continence rates ranging from 61% to 76% at about 2 years follow up.


CONCLUSIONS
In our experience, the AS-800 model artificial sphincter has a long term survival which rarely exceeds 8 to 9 years putting into question whether it or bladder neck reconstruction is the best long term solution for treating children with neurogenic incontinence. This question may be only answered by a randomized, controlled trial comparing these two modalities.
Spiess
Philippe E
PE
Division of Urology, Shriner's Hospital for Children, Montreal, Quebec, Canada.
Capolicchio
John Paul
JP
Kiruluta
George
G
Salle
Joao Pippi
JP
Berardinucci
Gina
G
Corcos
Jacques
J
D000293:Adolescent; D000328:Adult; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D016135:Spinal Dysraphism / Q000150:complications*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000150:complications / Q000601:surgery*; D016741:Urinary Sphincter, Artificial