Artificial urinary sphincter in congenital neuropathic bladder: Very long‐term outcomes

Objective Artificial urinary sphincter has been used to treat urinary incontinence in children with neuropathic bladder, although there are few studies reporting very long‐term results. We assess our experience over the last 27 years in the management of artificial urinary sphincter. Methods A retrospective study was performed in patients with neuropathic bladder in whom an artificial urinary sphincter was placed in our institution between 1994 and 2020. Demographic variables, pre‐ and post‐artificial urinary sphincter implantation urodynamic studies, long‐term outcomes, and postoperative complications were collected. Results An artificial urinary sphincter was implanted in 71 patients (median age 14.5; interquartile range 12.8–15.9), with a median follow‐up time of 17.2 years (interquartile range 9.8–23.9 years). Thirty‐nine patients underwent enterocystoplasty combined with artificial urinary sphincter placement and 32 underwent artificial urinary sphincter implantation alone, of whom 12 patients (16.9%) eventually required an enterocystoplasty because of unexpected bladder behavior changes, usually within 3 years of artificial urinary sphincter implantation. Adequate urinary continence was reported in 90.1% of patients, nine void their bladders spontaneously, and 62 need clean intermittent catheterization. Eighteen mechanical malfunctions occurred in 15 patients (21.1%), with an average artificial urinary sphincter working life of 15.1 ± 1.3 years. In five patients artificial urinary sphincter was removed due to infection or erosion. In 12 patients (30.8%), a continent catheterizable stoma was made (before or during the follow‐up) because of problems with clean intermittent catheterization through the urethra. Conclusion The very long‐term results of this study demonstrate that artificial urinary sphincter is an effective treatment for urinary incontinence in neuropathic bladder patients. Long‐term follow‐up is important to identify potential unexpected changes in bladder behavior in these patients.