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Long-term Continence Outcomes Following Bladder Neck Artificial Urinary Sphincters in Children and Young Adults
Jonathan T. Xu, MD, Konrad Szymanski, MD, Rosalia Misseri, MD, Richard Rink, MD, Mark Cain, MD, Martin Kaefer, MD, Joshua Roth, MD, PhD.
Riley Hospital for Children, Indianapolis, IN, USA.
BACKGROUND: Since the 1980s, the artificial urinary sphincter (AUS) has been implanted in children with neuropathic bladder and urinary incontinence to bolster bladder outlet resistance. However, long-term outcomes regarding bladder neck AUS durability and continence in this population remains unknown. Thus, we reviewed our institutional cohort of patients with bladder neck AUS to investigate these outcomes as these patients transition into adulthood.
METHODS: We queried our institutional database on 148 patients who underwent initial bladder neck AUS placements from 1980 to 2004. Following chart review, 107 patients (75 males and 32 females) were included in our analysis. At the time of last urologic follow-up, data on the presence of the original or replaced AUS, functionality, and patient-reported dryness outcomes were collected.
RESULTS: Of 107 patients followed, 57 patients had an AUS (34 original, 23 replaced) at time of last follow-up with median total device utility time of 25.2 years. The most common reason for AUS explanation for the remaining 50 patients was device erosion (30%). Among the 57 with an AUS, 32 (56%) underwent a surgical revision of their AUS at some point, most commonly for device malfunction and/or outgrowing their previous sphincter cuff. 31 of 57 patients continue to cycle their AUS, while the other 26 patients no longer cycle their AUS. Of available patient-reported continence, 23 of 32 patients (72%) self-reported dry from below. 12 of 23 patients (52%) with reported dryness no longer cycle their AUS.
CONCLUSIONS: Our results demonstrate that bladder neck AUS continues to assist with voiding function, continence, and dryness well into adulthood (median follow-up 28.1 years). While 53% of patients still cycle their AUS for voiding as adults, an additional 28% of patients who no longer cycle their AUS still retain them and are dry. We anticipate our results will better help clinicians counsel patients and families on expectations of function, continence, and dryness of the bladder neck AUS over time.
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