Alteration in detrusor behavior and the effect on renal function following insertion of the artificial urinary sphincter.

The neuropathic bladder may exhibit altered function following insertion of the artificial urinary sphincter. Detrusor hyperreflexia worsened in 7 patients following implantation of the device. However, the hyperreflexia may improve spontaneously once healing is complete. Detrusor areflexia with functional diminished compliance may remain unchanged (3 patients) or show an increased graphic gradient (10) postoperatively. These changes may result in hydronephrosis (3 patients) or urinary incontinence depending on the temporal relationship between the cuff pressure and the intravesical filling pressure. Possible explanations for the postoperative deterioration in the compliance are activation of the short neuron system, an increase in the alpha-adrenergic response or sensory receptor adaptation coupled with a severe partial lesion of the long neuron system. Because of the propensity for these changes to occur long-term followup is necessary.