Artificial urinary sphincter implantation for neurogenic bladder: a multi-institutional study in 107 children.

OBJECTIVES: To evaluate the outcome of implantation of the AMS 800 artificial urinary sphincter in children with neurogenic bladder. PATIENTS AND METHODS: The records of 107 children (74 boys and 33 girls) treated for neurogenic urinary incontinence by implantation of the AMS 800 artificial sphincter between 1983 and 1993 were reviewed retrospectively. The underlying cause of incontinence in 92 patients was spina bifida, the mean age at implantation was 13.7 years and 30 patients had undergone previous bladder neck surgery. Implantation was carried out in combination with another surgical procedure in 24.3% of patients. The mean follow-up was 61 months (minimum 12). RESULTS: The mean operational life of the sphincter was 56 months. No deaths occurred but removal of the artificial sphincter was necessary in 20 patients (19%). Surgical revision was not required in 44 patients (41%) but at least one revision was performed in 63 and more than one in 42. There were 21 mechanical failures, 40 surgical complications and 39 cases involving changes in the dynamics of bladder function. Of the 87 children (81%) in whom the device is still in place, 72 are completely continent (83%), 10 are slightly wet, and five are incontinent. The overall success rate was 77%. CONCLUSIONS: The results emphasize that for successful implantation of an artificial urinary sphincter in children, the pre-operative bladder capacity must be sufficient and previous surgery should not have been performed on the bladder neck, the site of choice for implantation in children. Sphincterotomy is not always necessary in paediatric patients. Children and parents should be informed of the high complication rate and the need for long-term follow-up.

[Pseudotumoral cystitis in the newborn infant and children. Problems of the differential diagnosis with bladder botryosarcoma. Apropos of 3 cases]. / Cystite pseudo-tumorale chez le nouveau-né et l'enfant. Problèmes de diagnostic différentiel avec le botryosarcome vésical. A propos de 3 observations.

The authors report three cases of pseudo-tumoral cystitis with one prenatally diagnosed by ultra-sound investigation. They point out the difficulties of such a diagnosis. Etiopathogenesis is discussed: though in most of the cases local irritation (due to urinary infection or physical causes) is involved, in several cases no origin is determined.

[Neonatal enterolithiasis (or intraluminal meconial calcifications). Apropos of 4 cases]. / Entérolithiase néonatale (ou calcifications méconiales intraluminales). A propos de quatre observations.

Calcified intraluminal meconium is rarely observed in newborn. Only 27 cases are related in litterature; the authors report 4 new cases and point out the role of intestinal obstruction (principaly anorectal malformations, but also atresia, meconium ileus or Hirschsprung disease). Pathogenesis is unknown, while intestinal urinary fistula is frequently described.