Assisted Laparoscopic Artificial Urinary Sphincter Implantation in Pediatric Population
Abstract Purpose We present our experience in posterior bladder approach using laparoscopic techniques to place an Artificial Urinary Sphincter (AUS). Material and Methods From 1990 to 2006. 132 pediatric patients with urinary incontinence underwent artificial urinary sphincter placement. In the last 4 years we used the posterior laparoscopic bladder approach in 8 patients to dissect the bladder neck under direct vision. There were 6 female and 2 male patients with a mean age of 8,7 years (range:3-20) and mean weight of 29,5 kg (range:14-72). The etiology of incontinence in all the patients was myelodysplasia. 3 patients had simultaneous surgical procedures. In 2 cases a laparoscopic Malone procedure was done and in the third we performed a subureteral endoscopic injection of bulking agent. After a complete laparoscopic exposure of the posterior and lateral walls of the bladder neck, a Phannestiel incision was made to place the components of the AUS-800. Results The mean follow up was 23 months (range:3-38). The average surgical time was 188 minutes (range 145-220), the mean oral feedin begun at 17,4 hs postop. (range 3-24) and hospital stays from operation until discharge were 1,4 days (range 1-2). We have no intraoperative complications. One patient presented a bilateral uretero vesical obstruction after the cuff activation that required an extravesical reimplantation. Conclusions The laparoscopic dissection of the bladder neck is safe and secure. It is not technical demandant and it gives the possibility to dissect the posterior wall of the bladder neck under direct vision. The results in achieving continence are similar to the reported in the literature.