Is an artificial sphincter the best choice for incontinent boys with Spina Bifida? Review of our long term experience with the AS-800 artificial sphincter.
Bibliographic record
Abstract
OBJECTIVE: We describe our long-term experience in a uniform population of Spina Bifida boys all treated with the AS-800 model artificial urinary sphincter (AUS) and compare our results to other treatment modalities available to children with neurogenic incontinence. MATERIALS AND METHODS: The complete medical records of 30 patients with insertion of the AS-800 were reviewed. All were boys having Spina Bifida with only one having prior bladder neck reconstruction. The mean age at insertion was 12.6 years and the average follow up was 6.5 years. Anticholinergic agents and self-intermittent catheterization were used concomitantly to the AUS in 21 and 22 patients respectively. RESULTS: In our series, 19 (63%) patients were completely dry, 6 (20%) were slightly wet, 5 (17%) were incontinent. The mean lifetime of all artificial sphincters was 4.7 years with no statistically significant difference in survival of those inserted at the bladder neck and bulbar urethra (4.6 and 4.9 years respectively). However, a survival analysis revealed a sharp drop after 100 months with only 8.3% of the sphincters implanted lasting beyond this point. There were a total of 32 revisions performed in 17 patients constituting a 0.164 revision rate/patient-years. The other surgical treatment available to these children is bladder neck reconstruction with reported continence rates ranging from 61% to 76% at about 2 years follow up. CONCLUSIONS: In our experience, the AS-800 model artificial sphincter has a long term survival which rarely exceeds 8 to 9 years putting into question whether it or bladder neck reconstruction is the best long term solution for treating children with neurogenic incontinence. This question may be only answered by a randomized, controlled trial comparing these two modalities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".