The Impact of the Artificial Urinary Sphincter in the Neurogenic Bladder on the Upper Urinary Tracts

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Abstract
The charts and x-rays of 120 neurogenic bladder patients who underwent artificial sphincter implantation for treatment of urinary incontinence between 1973 and 1984 were reviewed retrospectively. Patients were followed for 3 to 130 months (average 36.8 months). The upper urinary tracts remained unchanged in 108 patients (90 per cent). Renal growth in children was undisturbed. Transient hydroureteronephrosis occurred in 8 patients (6.7 per cent) and progressive hydroureteronephrosis occurred in 4 (3.3 per cent). A total of 26 patients with vesicoureteral reflux (39 ureters) underwent ureteral reimplantation. Our results indicate that 1) implantation of the artificial urinary sphincter in neurogenic bladder patients has minimal adverse impact on the upper urinary tracts, 2) follow-up should be long-term and should include an IVP, 3) outflow obstruction should be eliminated preoperatively by means of external sphincterotomy in male patients and bladder flap urethroplasty in female patients, 4) similarly, adequate emptying of the bladder always must be assured during followup, 5) if hydroureteronephrosis is detected early appropriate treatment can restore normal upper tracts, 6) the presence of previously damaged upper tracts without evidence of obstruction is not a contraindication for artificial sphincter implantation and 7) an antireflux operation in combination with artificial sphincter implantation is feasible.