The Pippi Salle procedure for neurogenic urinary incontinence in childhood: a three-year experience

A three-year retrospective study was performed to assess the place of the Pippi Salle bladder neck repair in the treatment of neurogenic bladder incontinence in both sexes in childhood.

All children who underwent the procedure between November 1995 and November 1998 were studied retrospectively. There were 18 children: 12 with spina bifida, 5 with sacral agenesis and 1 with an idiopathic neurogenic bladder. There were 11 boys and 7 girls. Their age was 3-14 years (median 7 years) and the length of follow-up was 7 months to 3 years (median 2 years). A midline bladder wall flap was fashioned in all patients. The procedure was performed alone (n = 5) or in combination with a sigmoid colocystoplasty (n = 9) or a Mitrofanoff catheterisable stoma (n = 2) or both (n = 2).

Diurnal continence (3 hours or more) was achieved in 11 of the 18 children (61%); 2 are dry for 2-2.5 hours and 5 are incontinent. Eight of the 18 children (44%) are completely dry during the night, 2 are damp and 8 are incontinent. Twelve children (67%) needed oxybutynin to maintain a good result. Complications arose in 5 children (28%): difficulty with catheterisation (n = 4) and pelvic abscess (n = 1). Seven children (39%) subsequently required further operations: exploration of bladder for urine leak (n = 2), reinsertion of dislodged catheter (n = 1), drainage of pelvic abscess (n = 1), bladder neck injection with macroplastique (n = 1) and bladder neck closure (n = 2).

The Pippi Salle bladder neck repair has an undoubted place in the management of neurogenic urinary incontinence in childhood. However, in our experience, it has a relatively high complication rate and failure rate.