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Combined use of bowel and the artificial urinary sphincter in reconstruction of the lower urinary tract: infectious complications.

Combined use of the artificial urinary sphincter and bowel in reconstruction of the lower urinary tract is currently being performed with increasing frequency. We reviewed our experience with 31 patients undergoing augmentation cystoplasty and insertion of the artificial urinary sphincter with respect to device infections to determine if a single operation was associated with increased morbidity compared to staged procedures. Of the patients who underwent simultaneous reconstruction 50% had prosthetic infections as opposed to 9.5% when the procedure was staged. More than half of the infections presented longer than 1 year after placement of the artificial urinary sphincter. The lowest incidence of device infection occurred in patients who underwent a staged procedure with implantation of the artificial urinary sphincter initially followed by augmentation cystoplasty. The discrepancy in infection rates between single and staged procedures is dramatic in this series and, therefore, a staged approach is recommended to decrease infectious complications.