Treatment of neurogenic male urinary incontinence related to intrinsic sphincter insufficiency with an artificial urinary sphincter: a French retrospective multicentre study

Abstract

Study Type – Therapy (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Intermittent catheterism is, in 2011, the gold standard of care for neurogenic bladder. Artificial urinary sphincter is also a gold standard for sphincteric insufficiency. If a patient with a neurogenic bladder needs needs an artificial urinary sphincter, the risk of urethral erosion is increased. This article describes the position of the device around the bladder neck to decrease this complication. OBJECTIVE To assess results and morbidity of the periprostatic insertion of an artificial urinary sphincter (AUS) in adult male patients with a neurogenic bladder. PATIENTS AND METHODS A retrospective study was carried out on 51 adult male patients operated on in four urologic academic wards from April 1988 to January 2008. Among these patients, 31% (16/51) had spina bifida and 69% (35/51) had spinal cord injury. All patients suffered urinary incontinence secondary to sphincteric deficiency, and this was associated with detrusor overactivity in 39% of them (leading in these cases to an added bladder augmentation). Perfect continence was defined as a period of dryness of at least 4 h between two self‐intermittent catheterizations (SIC) or spontaneous micturitions, moderate incontinence as nocturnal leakage or need to wear protection once during the day or for stress leakage, while severe incontinence was defined as uncontrollable leakage causing patient discomfort. RESULTS Mean age at the procedure was 35 years (18–58). Mean follow‐up was 83 months (CI 95%, 65–101). At the end of the study, 15 patients (29.4%) were lost to follow‐up. One patient (2%) died shortly after the procedure from a pulmonary infection. Post‐operative morbidity was observed in 19% (10/50) of the patients (8 urinary tract infection, 1 failure to perform SIC, 1intracranial hypertension). Of the patients in our study 74% had perfect or moderate continence with a working AUS after a 10‐year follow‐up CONCLUSIONS We present a specific study on adult patients with a neurological lesion leading to bladder dysfunction treated by a periprostatic AUS. This procedure was effective in restoring urinary incontinence in the vast majority of our patients with an acceptable morbidity.