The artificial urinary sphincter in patients with spinal cord lesion: description of a modified technique and clinical results.

Abstract

The artificial sphincter is the method of choice in patients with stress urinary incontinence due to neurogenic bladder dysfunction. However, long-term studies reveal a high revision rate. To determine the success and revision rates of a modified implant. In a retrospective analysis, the results of 51 consecutive patients presenting at a private paraplegic center with neurogenic bladder dysfunction (meningomyelocele: n=8; spinal cord injury: n=37; others: n=6) who underwent implantation of an artificial sphincter at the bladder neck using a port instead of a pump were evaluated. Subjective and objective cure rates were assessed by video-urodynamics and a standardized interview. After a mean follow up of 95.9 mo, 70.6% of the patients were objectively and subjectively cured; 90.2% were completely continent in everyday life. Mean bladder capacity (465 ml) and compliance (41.7 ml/cm H(2)O) were normal. Sixteen patients underwent 18 revisions (35.3%). One implant had to be permanently removed. This is a single-centre study; thus, the results have to be confirmed. With a long follow up of 8 yr, the modification presented by our group proved to be highly successful, reliable, safe, and even cost-effective. Therefore, it seems to be a valuable tool for the treatment of this group of patients.