Research Article|Articles in Press

Simultaneous bladder augmentation and artificial urinary sphincter placement in children with neuropathic urinary incontinence. Is it safe to perform? Long-term results

Published:February 09, 2023DOI:



      Simultaneous performance of artificial urinary sphincter (AUS) placement and bladder augmentation (BA) in patients with neuropathic bladder is currently controversial.


      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.


      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.


      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.


      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
      • Non-mechanical complications; n(%)
      3 (11.1) 1 (8.3) 0.758
      • Bladder neck perforation
      1 (3.7) 1 (8.3)
      • Vulvar labium erosion
      1 (3.7)
      • Bowel obstruction
      1 (3.7)


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