REVIEW ARTICLE: SURGICAL MANAGEMENT OF URINARY INCONTINENCE IN CHILDREN WITH NEUROGENIC SPHINCTERIC INCOMPETENCE

Abstract

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Jan 2000REVIEW ARTICLE: SURGICAL MANAGEMENT OF URINARY INCONTINENCE IN CHILDREN WITH NEUROGENIC SPHINCTERIC INCOMPETENCE JOHN V. KRYGER, RICARDO GONZÁLEZ, and JULIA SPENCER BARTHOLD JOHN V. KRYGERJOHN V. KRYGER , RICARDO GONZÁLEZRICARDO GONZÁLEZ , and JULIA SPENCER BARTHOLDJULIA SPENCER BARTHOLD View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68031-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There are many alternatives for the surgical treatment of children with neurogenic sphincteric incompetence. However, there is no consensus regarding appropriate evaluation and long-term management in these patients. We critically reviewed the literature and compare the outcomes of each technique. Materials and Methods: A MEDLINE search was performed to select all relevant peer reviewed publications since 1966. In addition, the bibliography of each article was examined for additional published resources. The results of each technique were compared in 7 objective categories, including continence (defined as complete dryness for 4 hours between voidings or catheterizations), the need for intermittent catheterization, effects on bladder compliance, the need for bladder augmentation, upper tract changes, other complications and the revision rate. Results: Long-term results of artificial urinary sphincter placement were superior and reproducible in terms of continence, preservation of volitional voiding and avoidance of bladder augmentation. Revision rates of various procedures were similar but the incidence of complications was highest with the Kropp procedure. Long-term published data were limited in regard to bladder neck sling, reconstruction, injection, suspension and urethral lengthening techniques. Conclusions: Long-term published data support artificial urinary sphincter creation as first line surgical management of neurogenic sphincteric incontinence. Girls who already depend on intermittent catheterization may benefit equally from a sling procedure if successful long-term continence is demonstrated in future studies. References 1 : The urological fate of young adults with myelomeningocele: a three decade follow-up study. Eur Urol1997; 32: 213. Google Scholar 2 : Urodynamic evaluation of the continence mechanism following urethral lengthening—reimplantation and enterocystoplasty. J Urol1991; 146: 535. Link, Google Scholar 3 : Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol1972; 107: 458. Abstract, Google Scholar 4 : Impact of an intermittent catheterization program on children with myelomeningocele. Pediatrics1985; 76: 892. Google Scholar 5 : Results of clean intermittent catheterization for children with neurogenic bladders. Urology1983; 22: 479. Google Scholar 6 : Clean intermittent catheterization in the management of the neurogenic bladder in children. J Urol1984; 132: 526. Link, Google Scholar 7 : Pubovaginal sling procedure for the management of urinary incontinence in a myelodysplastic girl. J Urol1982; 127: 744. Link, Google Scholar 8 : Alteration in detrusor behavior and the effect on renal function following insertion of the artificial urinary sphincter. J Urol1986; 136: 632. Link, Google Scholar 9 : Artificial urinary sphincters and the detrusor pressure in the neuropathic bladder. Br J Urol1996; 78: 808. Google Scholar 10 : Prognostic value of urodynamic testing in myelodysplastic patients. J Urol1981; 126: 205. Link, Google Scholar 11 : Bladder augmentation in the pediatric neuropathic bladder. J Urol1983; 129: 552. Link, Google Scholar 12 : Urinary undiversion in myelodysplasia: criteria for selection and predictive value of urodynamic evaluation. J Urol1980; 124: 89. Link, Google Scholar 13 : Voiding dysfunction: diagnosis, classification, and management. In: . St. Louis: Mosby1996: 1220. chapt. 26B. Google Scholar 1