Long-term results of the artificial urinary sphincter in male patients with neurogenic bladder.

The records of patients who received an artificial urinary sphincter at the University of Minnesota were reviewed. A total of 19 patients fulfilled the following criteria: male gender, neurogenic sphincteric incompetence, no previous surgery on the bladder neck, myelodysplasia and more than 5 years of followup. Mean age at the time of implantation was 8 years, mean age at the last followup was 16.5 years and mean followup was 8 years. At the last followup 16 patients (84.2%) were continent and 3 were expected to regain continence after revision or bladder augmentation. At the last followup 78.9% of the patients were on anticholinergic medications and 73.8% voided by clean intermittent catheterization. A fourth of the patients voided spontaneously. The annual revision rate was 0.2 revisions per patient. Seven patients (36.8%) have undergone or will require bladder augmentation. Upper tract dilatation developed in 2 patients and the function of 1 of 38 renal units at risk was lost. We conclude that the artificial urinary sphincter is an excellent modality for the initial surgical treatment of neurogenic sphincteric incompetence in male patients. Careful patient selection and lifelong surveillance are essential to success and safety.