Artificial urinary sphincter in patients with neurogenic bladder dysfunction.

OBJECTIVE: To assess the role of the artificial urinary sphincter (AUS) in the management of sphincter weakness incontinence in neuropathic patients. PATIENTS AND METHODS: Ninety patients (75 male and 15 female, mean age 26 years, range 13-62) with neurogenic bladder dysfunction (71 with congenital and 19 with acquired cord lesions) who underwent implantation of an AUS were reviewed. All patients were followed up for a minimum of one year after the initial implantation of the sphincter (mean 4 years, range 1-10). Pre-operative video-urodynamics demonstrated sphincter weakness incontinence in all patients, with 24 patients having an acontractile-type bladder. Of 66 patients with intermediate-type bladders, 52 underwent cystoplasty.
RESULTS: Eighty-three patients (92%) were continent both night and day, three were occasionally damp and controlled by pharmacotherapy, and four had a persistent poor result. Of the 66 patients with detrusor hyper-reflexia, 52 (79%) required a cystoplasty to achieve continence and 14 (21%) were controlled with anti-cholinergic therapy. The re-operation rate was 28% (25/90) and complications included six infections, seven erosions, eight system failures, two pump failures, one sheered tube and one rectal and one bladder perforation. Seventy (78%) of the patients currently perform intermittent catheterization to treat high post-voiding residual urine volumes.
CONCLUSIONS: A rate of continence > 90% was achieved in these neurogenic patients after implantation of an AUS and we recommend a simultaneous cystoplasty in patients with detrusor overactivity.