Summary
Introduction
Simultaneous performance of artificial urinary sphincter (AUS) placement and bladder
augmentation (BA) in patients with neuropathic bladder is currently controversial.
Objective
The aim of this study is to describe our very long-term results after a median follow-up
of 17 years.
Study design
A retrospective single-center case-control study was performed in patients with neuropathic
bladder treated in our institution between 1994 and 2020, in whom AUS placement and
BA were performed simultaneously (SIM group) or sequentially at different times (SEQ
group). Demographic variables, hospital length of stay (LOS), long-term outcomes and
postoperative complications were compared between both groups.
Results
A total of 39 patients (21 males, 18 females) were included, with a median age of
14.3 years. BA and AUS were performed simultaneously at the same intervention in 27
patients, and sequentially in different interventions in 12 cases, with a median of
18 months between both surgeries. No demographics differences were observed. SIM group
had a shorter median LOS when compared to SEQ group, considering the two sequential
procedures (10 vs. 15 days; p = 0.032). Median follow-up was 17.2 years (interquartile
range 10.3–23.9). Four postoperative complications were reported, 3 patients in SIM
group and 1 case in SEQ group, with no statistically significant differences between
them (p = 0.758). Adequate urinary continence was achieved in more than 90% of patients
in both groups.
Discussion
There are scarce recent studies comparing the combined performance of simultaneous
or sequential AUS and BA in children with neuropathic bladder. The results of our
study show a much lower postoperative infection rate than previously reported in the
literature. It is a single-center analysis with a relatively small sample of patients
although it is among the largest series published so far, and presents the longest
long-term follow-up with more than 17 years of median follow-up time.
Conclusion
Summary Table
| SIM group (n = 27) | SEQ group (n = 12) | P-value | |
|---|---|---|---|
| Long-term urinary continence; n (%) | 25 (92.6) | 11 (91.7) | 0.582 |
| Mechanical complications (balloon rupture); n(%) | 5 (18.5) | 2 (16.7) | 0.542 |
| Sphincter life (years); median (Q1-Q3) | 15.1 (1.7) | 14.5 (2.1) | 0.125 |
|
3 (11.1) | 1 (8.3) | 0.758 |
|
1 (3.7) | 1 (8.3) | |
|
1 (3.7) | – | |
|
1 (3.7) | – |
Keywords
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Article info
Publication history
Published online: February 09, 2023
Accepted:
January 30,
2023
Received in revised form:
January 20,
2023
Received:
February 3,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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- Commentary to ‘Simultaneous bladder augmentation and artificial urinary sphincter placement in children with neuropathic urinary incontinence. Is it safe to perform? Long-term results'Journal of Pediatric Urology
- PreviewOne of the most challenging subjects of pediatric urology is, without a doubt, urinary incontinence in children with neuropathic bladder. Urinary incontinence in neuropathic bladders may be related to a single factor or a combination of different factors such as sphincteric incompetency, detrusor overactivity and low bladder compliance/capacity. Accordingly, there are different strategies along with clean intermittent catheterization starting with anticholinergics, beta 3 agonists and followed by bladder neck injection, intravesical botulinum toxin injection, and procedures increasing bladder outlet resistance and/or bladder augmentation when the previous treatments fail.
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