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[Selected secondary reconstructive procedures for improvement of urinary incontinence in bladder exstrophy and
M Stehr1, T Schuster, H G Dietz
1Kinderchirurgischen Klinik des Dr. v. Haunerschen Kinderspitals, München, Deutschland. MaximilianStehr@kk-i.med.uni-muenchen.de
Insights
Secondary reconstruction surgeries successfully restored urinary continence in children with severe genitourinary malformations. Advanced surgical techniques offer hope for previously untreatable incontinence, improving quality of life.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Urinary incontinence significantly impacts quality of life in patients with genitourinary tract and pelvic floor malformations.
- Previous reconstructive surgeries often fail to resolve these complex conditions.
Observation:
- Seven pediatric patients (ages 5-14) with severe urinary incontinence due to conditions like bladder exstrophy, myelomeningocele, and bladder duplication underwent secondary reconstruction.
- All patients had previously experienced complete urinary incontinence despite multiple prior operations.
Findings:
- Various secondary reconstruction techniques were employed, including bladder-neck plasty, ileum augmentation, continent appendicostoma (Mitrofanoff), Mainz pouches (I and II), and Monti's technique.
- Postoperatively, six patients achieved complete urinary continence, and one regained partial continence.
- Bladder emptying was managed via clean intermittent catheterism (CIC), except for one patient with a Mainz-II pouch.
Implications:
- Complex genitourinary malformations and pelvic floor anomalies do not preclude achieving complete urinary continence.
- Recently developed surgical techniques offer effective solutions for previously intractable urinary incontinence in children.
- Artificial sphincter systems are not recommended for primary use in children due to a high complication rate.
Abstract:
Partial or complete urinary and stool incontinence due to malformation of the genito-urinary tract and the pelvic floor despite of several operative reconstructions is the most important handicap in the patients life. Often this problems seems to be unsoluble. In recent time we secondarily reconstructed 7 patients suffering from urinary incontinence: 1 girl and 4 boys with bladder ekstrophy; 1 boy with a complex anomaly with menigomyelocele, sinus urogenitalis, single kidney with vesicorenal reflux and neurogene bladder; 1 boy with complex anomaly of the pelvis and the lower limbs with duplication of the bladder with an ekstrophic left part. All patients underwent multiple operative trials of reconstruction. Until that time all patients suffered from complete urinary incontinence. At the age of 5 to 14 years we performed the secondary reconstruction: bladder-neck-plasty and ileumaugmentation (3 patients), closure of the bladder-neck, ileumaugmentation and a continent appendicostoma (Mitrofanoff's method)), Mainz-I-pouch and a continent appendicostoma respectively ileostoma (Monti's technique) (2 patients), Mainz-II-pouch. With a normal bladder-capacity all patients are completely continent postoperatively; one patient has regained partial continence. The emptying of the bladder is carried out by clean intermittent catheterism (CIC) with the exception of the one patient with the Mainz-II-pouch. Even in patients with complex anomalies of the pelvic floor and the genitourinary tract complete urinary continence is possible in consequence of recently developed operative techniques. Because of a high rate of complications we reject the primary use of artificial sphincter systems for children.