Augmentation cystoplasty and the artificial genitourinary sphincter.

In 18 patients with urinary incontinence secondary to decreased bladder compliance and sphincteric incompetence, augmentation cystoplasty and the artificial genitourinary sphincter were combined successfully to produce complete urinary control. Insertion of the sphincter was simultaneous with augmentation cystoplasty in 11 patients. In 6 patients the artificial sphincter was placed before augmentation cystoplasty. One patient underwent placement of a sphincter subsequent to enterocystoplasty and failed Young-Dees reconstruction of the vesical neck. It is noteworthy that in all 6 patients who underwent sphincteric placement before bladder augmentation decreased bladder compliance and urinary incontinence developed with time, and upper tract deterioration developed in 2 patients. Fifteen patients empty the bladder by intermittent self-catheterization, and 3 teenagers void by relaxation of the pelvic musculature and abdominal straining. In selected patients with complex urinary incontinence augmentation cystoplasty and placement of an artificial genitourinary sphincter cuff can be combined successfully without increase in morbidity over that with either procedure performed separately.