Authors' objectives:

This report aims to summarise the available evidence on the AMS 800 artificial urinary sphincter for children with urinary incontinence.

Authors' results and conclusions: A clean intermittent catheterization in combination with pharmacological treatment with anticolinergic drugs can lead to continence in 50% of the patients. Surgical techniques can be the only alternative for patients with small bladders or with little compliance, or with hyperreflexia or presence of significant sphincter weakness. Among the surgical techniques used, the artificial urinary sphincters (AUS) is one of the most accepted techniques which has shown the best results. AMS 800 is basically a hydraulic device made of silicone. The system can be activated or disactivated to carry out the sphincter function. The standard approach to implant the AUS is suprapubic. Not all the patients with urinary incontinence have the adequate characteristics to have an AUS. The following requirements must be fulfilled for a better AUS functioning: 1.Patient's psycophysical aptitude: Emotional maturity and motor skill to perform intermittent catheterism. 2.Child and family motivation. Adequate age: Because collaboration is necessary, the child must be at least 9-10 years old. In general, in almost all the studies, the patients were over 7 years old, although it is possible to use them in younger patients if adequate conditions are given. 3.Competent vesicoureteral junction. 4.Adequate bladder capacity (consider performing bladder enlargement) 5.Good bladder compliance and absence of hyperreflexia (consider performing bladder enlargement) 6.Sterile urine

Authors' recommendations: Long term success of AUS has been well documented in various clinical trials, with continence rates of about 60% at 5 years or more.The AMS 800 is nowadays the most widely used model and also the one with which the best long term results have been achieved. Although the AUS survival is long, it has been questioned whether other surgical techniques such as bladder neck reconstruction would not be a better option since it would offer patients a more definite solution. Up until now, there have not been clinical trials that could clarify this issue.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)