Overall 37 patients with a median age of 12 years [IQR 9-16] were included (15 females, 22 males). Median follow up was 18,7 years (IQR 0,3-31,4).
25 had a neurogenic ISD, mostly from spinal dysraphism, 5 had a congenital sphincter agenesis, 3 had a post-prostatic rhabdomyosarcoma ISD and 2 an epispadias. 1 patient had a gunshot pelvic trauma and 1 a pelvic surgery for Hirschsprung syndroma, both resulting in ISD.
In patients with neurogenic bladder, the main preoperative voiding mode was spontaneous voiding (n=35, 95%), often with abdominal thrust (or Crédé). 2 patients practiced clean
intermittent catheterization (self-catheterization or by caregiver).
All patients had a preoperative urodynamic evaluation assessing the ISD before device implantation.
48% had previously undergone surgery, mostly for vesico-ureteral reflux or cryptorchidism.
All implantation were performed in open approach except for one young female patient (robotic approach).
In male, the cuff implantation was pericervical in 2/3 cases (n=25). For the remaining patients, the cuff was located in a bulbar position. For all female patients, the cuff was implanted around the bladder neck.
The median size if the cuff was 6cm (IQR 4-7,5). In 81%, a 61-70 cmH2O balloon was implanted.
5 patients experienced early complications (< 30 days after implantation) : 3 patients had a urinary tract infection, 1 leading to device explantation 21 days after implantation. 2 had acute urinary retention, resolved after few days of cathetirization.
At last follow-up, 83,3% (n=30) still had a functional AUS in place.
10 (27%) patients underwent explantation (appendix 1) due to erosion or infection. Only 4 patients had a second device implantation after explantation of the first one. Among those patients, 3 underwent explantation of the second device.
16 (43%) underwent revision (appendix 2), with a median delay of 114 months (IQR 0-223).
10 patients have had an augmentation cystosplasty for compliance degradation non-responding to anticholinergic treatments.
18 (49%) patients were spontaneously voiding, 17 patients were practicing self-catheterization, 1 underwent an ileal urinary derivation and 1 had an indwelling catheter.
At last follow up, the overall continence was satisfaying, with 30 patients (81%) requiring 0 pad/day, 4 patients requiring 1 pad/day and only one who was fully incontinent.
As for the patients still having a functional AUS, 27 (90%) patients wore 0 pad/day and 3 (10%) patients wore 1 pad/day.