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The endoscopic treatment of incontinence in children
1Division of Pediatric Urology, Bambino Gesù Children's Hospital, via Giancinto Carini 45, 00152 Rome, Italy. caione@opbg.net
Insights
Endoscopic injection of bulking agents offers a minimally invasive option for improving urinary continence in children with congenital conditions or neuropathic bladder. Encouraging results suggest this approach can enhance dry intervals and bladder capacity.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urodynamics
Background:
- Urinary continence can be challenging in children with congenital lower urinary tract malformations (e.g., bladder exstrophy) or neurogenic bladder dysfunction.
- Traditional treatments may involve open surgery, which can be invasive.
Purpose of the Study:
- To evaluate the efficacy of endoscopic injection of bulking agents as a minimally invasive treatment for urinary incontinence in children.
- To assess the potential of this procedure in improving dry intervals and functional bladder capacity.
Main Methods:
- Endoscopic injection of bulking substances into the bladder neck or posterior urethra.
- Procedure can be performed as a primary treatment or adjunctively after open bladder neck surgery.
- Assessment of functional bladder capacity was also considered.
Main Results:
- The procedure is minimally invasive, offering a potentially better dry interval for affected patients.
- Encouraging preliminary results have been observed, though longer follow-up is recommended.
- Biodegradable implants show promise as safe and reliable bulking agents.
Conclusions:
- Endoscopic bulking agent injection is a promising minimally invasive option for pediatric urinary incontinence.
- The technique can improve continence and increase functional bladder capacity in select pediatric cases.
- Ongoing research focuses on identifying optimal, safe, and reliable bulking substances.
Abstract:
The achievement of urinary continence in children may be very difficult with some congenital malformations of the lower urinary tract, such as bladder exstrophy, or in some neurogenic dysfunctions, such as neuropathic bladder. Endoscopic injection of bulging substances into the bladder neck or posterior urethra may be regarded as a minimally invasive procedure that may provide a better dry interval in these patients. Endoscopic treatment can be performed as either a primary or adjunctive procedure after open bladder neck surgery. It is also of use to increase the functional bladder capacity in some children. Although longer follow-up is wise, results so far are encouraging. The search for a safe and reliable substance to use is still ongoing, and the new available biodegradable implants seem adequate.