Zurich Open Repository and
Archive
University of Zurich
Main Library
Strickhofstrasse 39
CH-8057 Zurich
www.zora.uzh.ch

Year: 2011

Editorial comment

González, R

DOI: https://doi.org/10.1016/j.juro.2010.11.094

Posted at the Zurich Open Repository and Archive, University of Zurich
ZORA URL: https://doi.org/10.5167/uzh-58197
Journal Article
Accepted Version

Originally published at:
González, R (2011). Editorial comment. The Journal of Urology, 185(4):1447-1448.
DOI: https://doi.org/10.1016/j.juro.2010.11.094

https://doi.org/10.1016/j.juro.2010.11.094
https://doi.org/10.5167/uzh-58197
https://doi.org/10.1016/j.juro.2010.11.094


Editorial Comment 
Ricardo González 

Kinderspital Universität Zürich, Zurich, Switzerland, Kinderkrankenhaus auf der Bult, 
Hannover, Germany; and Thomas Jefferson University, Philadelphia, Pennsylvania 

Refers to 

Yuval Bar-Yosef, Miguel Castellan, Devandra Joshi, Andrew Labbie, Rafael Gosalbez: Total 
Continence Reconstruction Using the Artificial Urinary Sphincter and the Malone Antegrade 
Continence Enema. The Journal of Urology, Volume 185, Issue 4, April 2011, Pages 1444-
1448 

The authors reemphasize 2 old concepts of 1) the implantation of an artificial urinary 
sphincter with simultaneous intestinal surgery (1,2) and 2) the importance of achieving 
urinary and fecal continence simultaneously (3). The title should have included the term 
enterocystoplalsty since 38% of the patients needed it either to achieve continence or preserve 
the upper tracts. Since the shortest followup is only 8 months, I would anticipate that in the 
future more patients in this series will require augmentation and may become dependent on 
intermittent catheterization. 

Finally, the conclusion that the results are durable needs to be taken with caution. With an 
average age at surgery of 10 years, the real question is how these patients will fare at age 30 
and beyond. I perform reconstructive procedures for urinary and fecal incontinence in 
children but advise the parents that these solutions may be temporary. Nevertheless, I believe 
that the achievement of a diaper-free status is important in childhood and adolescence. This 
article is worth reading to remind surgeons treating children with spina bifida of the 
importance of taking a holistic approach to the treatment of urinary and fecal incontinence. 

References 
1. R. González, D.H. Nguyen, N. Koleilat et al. Compatibility of enterocystoplasty and the 

artificial urinary sphincter. J Urol, 142 (1989), p. 502 
2. R. González, B. Ludwikowski, M. Horst. Determinants of success and failure of 

seromuscular colocystoplasty lined with urothelium. J Urol, 182 (2009), p. 1781 
3. R. González, S. Myers, J. Franc-Guimond et al. Surgical treatment of neuropathic urinary 

incontinence in 2005When, what, and how?  J Pediatr Urol, 1 (2005), p. 378 

 


	Editorial Comment
	References