Treating neuropathic incontinence in children with seromuscular colocystoplasty and an artificial urinary sphincter.

Abstract

To review the results of artificial urinary sphincter (AUS) implantation combined with seromuscular colocystoplasty (SCLU) in the treatment of mixed neurogenic urinary incontinence in children. Patients (27, six females) who had undergone SCLU were interviewed, and their charts and imaging studies reviewed retrospectively. Their urodynamic data were analysed and bladder capacity, end-filling pressure, safe capacity and percentage of expected capacity for age compared before and after surgery. Continence was defined as dryness between catheterizations or voiding with no need for protective pads. The mean (sd) follow-up since the SCLU was 1.7 (1.1) years; continence was achieved in 24 of the 27 (89%) patients with no additional procedures. No significant upper tract changes developed. Bladder capacity, safe capacity for age and end-filling pressure were all improved significantly. There were two AUS erosions necessitating removal and in one patient the augmentation failed. Six patients early in the series developed an 'hourglass' deformity that required correction. Modifications to the technique to avoid this complication are discussed. For children with neuropathic incontinence who require both augmentation of outlet resistance and bladder storage capacity, the combination of the AUS and SCLU effectively achieves continence with no upper tract deterioration. SCLU is also the preferred method of augmentation when adverse bladder changes occur after implanting the AUS.