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Published on: November 30, 2010
Treating neuropathic incontinence in children with seromuscular colocystoplasty and an artificial urinary sphincter
R González1, R Jednak, J Franc-Guimond
1Divisions of Pediatric Urology, University of Miami, Florida 33101, USA. rgonzal4@med.miami.edu
Insights
Artificial urinary sphincter (AUS) combined with seromuscular colocystoplasty (SCLU) effectively treats neurogenic incontinence in children. This combined approach improved bladder function and achieved continence in 89% of patients.
Area of Science:
- Pediatric Urology
- Neurourology
- Surgical Innovation
Background:
- Neurogenic bladder dysfunction often leads to mixed urinary incontinence in children.
- Management requires addressing both outlet resistance and bladder storage capacity.
- Previous treatments have limitations, necessitating combined surgical approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of combining artificial urinary sphincter (AUS) implantation with seromuscular colocystoplasty (SCLU) in pediatric patients.
- To assess the impact of this combined approach on urinary continence and upper tract status.
- To analyze urodynamic parameters before and after the combined surgical intervention.
Main Methods:
- Retrospective review of 27 pediatric patients (six female) who underwent SCLU.
- Analysis of urodynamic data, including bladder capacity, end-filling pressure, and safe capacity.
- Definition of continence as dryness between catheterizations or voiding without pads.
Main Results:
- Continence was achieved in 89% (24/27) of patients post-operatively without further procedures.
- Significant improvements were observed in bladder capacity, safe capacity for age, and end-filling pressure.
- Two cases of AUS erosion and one augmentation failure occurred; six patients required correction for 'hourglass' deformity.
Conclusions:
- The combination of AUS and SCLU is an effective treatment for pediatric neuropathic incontinence, improving continence and preventing upper tract deterioration.
- SCLU serves as a preferred augmentation method when adverse bladder changes arise post-AUS implantation.
- Technique modifications are discussed to mitigate complications like 'hourglass' deformity.
Purpose:
To review the results of artificial urinary sphincter (AUS) implantation combined with seromuscular colocystoplasty (SCLU) in the treatment of mixed neurogenic urinary incontinence in children.
Patients And Methods:
Patients (27, six females) who had undergone SCLU were interviewed, and their charts and imaging studies reviewed retrospectively. Their urodynamic data were analysed and bladder capacity, end-filling pressure, safe capacity and percentage of expected capacity for age compared before and after surgery. Continence was defined as dryness between catheterizations or voiding with no need for protective pads.
Results:
The mean (sd) follow-up since the SCLU was 1.7 (1.1) years; continence was achieved in 24 of the 27 (89%) patients with no additional procedures. No significant upper tract changes developed. Bladder capacity, safe capacity for age and end-filling pressure were all improved significantly. There were two AUS erosions necessitating removal and in one patient the augmentation failed. Six patients early in the series developed an 'hourglass' deformity that required correction. Modifications to the technique to avoid this complication are discussed.
Conclusions:
For children with neuropathic incontinence who require both augmentation of outlet resistance and bladder storage capacity, the combination of the AUS and SCLU effectively achieves continence with no upper tract deterioration. SCLU is also the preferred method of augmentation when adverse bladder changes occur after implanting the AUS.
