Use of the artificial urinary sphincter to manage persistent urethral incontinence after an ileovesicostomy

Introduction: Persistent urethral incontinence occurs in approximately 30% of patients after ileovesicostomy. We report a case of a patient with neurogenic bladder dysfunction due to spinal cord injury managed with ileovesicostomy and an artificial urinary sphincter (AUS) to treat persistent incontinence. Methods: A case report with 2-year follow-up is presented after review of the computerized medical record. Results: Persistent urethral incontinence was eliminated after AUS treatment. However, due to de novo autonomic dysreflexia, nighttime deactivation of the device was required. Conclusions: To our knowledge this is the first case reported of an individual with neurogenic bladder dysfunction managed with an ileovesicostomy to limit elevated detrusor pressures and an AUS to control persistent urethral incontinence. The combination of these procedures appears to be a safe, effective, and less invasive option than an ileovesicostomy followed by bladder neck closure or conversion to ileal conduit. However, the possibility of de novo autonomic dysreflexia must be considered.