title: [Lower urinary tract reconstruction by augmentation cystoplasty and insertion of artificial urinary sphincter cuff only: long term follow-up].
abstract: OBJECTIVE
  To review retrospectively our long-term experience with augmentation cystoplasty and simultaneously insertion of artificial urinary sphincter cuff only for lower urinary tract reconstruction in cases of mixed bladder and sphincteric dysfunction. We tried to assess the postoperative continence status, as well as the associated morbidity, focusing upon infections, urethral erosion and revision rates.
  
  
  METHODS
  Eleven patients with urinary incontinence due to a small capacity and low compliant bladder, combined with incompetent outlet, underwent lower urinary tract reconstruction by augmentation cystoplasty and simultaneous insertion of a bladder neck sphincter cuff only (AMS, model AS-800). Mean age was 29 years (range 18-45). The etiology of voiding dysfunction was a seminal cord injury in 6 patients, myelomeningocele in 2 and spinal cord surgery in 1, bladder exstrophy (1) and pelvic trauma combined with spinal cord injury (1).
  
  
  RESULTS
  With mean follow-up period of 115 months (range 45-141), 8 patients (73%) achieved continence on clean intermittent catheterization without any further interventions. Two patients required insertion of sphincter pump and reservoir at a second stage to achieve full continence and subsequently one was removed due to erosion (overall continence rate of 82%). In another patient, the cuff located at the level of the bladder neck has eroded and was removed. None of the patients has experienced an infection of the device in the immediate postoperative period, neither thereafter.
  
  
  CONCLUSIONS
  Insertion of sphincter cuff only during augmentation cystoplasty may be sufficient to achieve continence in many incontinent patients who may not be cured by bladder augmentation alone. The procedure is technically easy and is not associated with increased risk of injury to the augmented bladder, neither with subsequent infectious complications.
authors.affiliation: Urologie, Centre Medical Chaim Sheba, Tel-Hashomer affilié à la Faculté de Médecine de Tel Aviv, Israël. yoram.mor@sheba.health.gov.il
authors.forename: Yoram
authors.initials: Y
authors.lastname: Mor
authors.forename: Ilan
authors.initials: I
authors.lastname: Leibovitch
authors.forename: Jacob
authors.initials: J
authors.lastname: Golomb
authors.forename: Jacob
authors.initials: J
authors.lastname: Ben-Chaim
authors.forename: Andrei
authors.initials: A
authors.lastname: Nadu
authors.forename: Jehonathan H
authors.initials: JH
authors.lastname: Pinthus
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007082:Ileum / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D013520:Urologic Surgical Procedures / Q000379:methods
vernacular_title: Reconstruction du bas appareil urinaire par entérocystoplastie d'agrandissement et mise en place isolée d'une manchette de sphincter artificiel.