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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Outcome of continence procedures in the pediatric patient: a single institutional experience
Emily E Cole1, Mark C Adams, John W Brock
1Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
Insights
Pediatric lower urinary tract reconstruction offers various continence procedures for voiding dysfunction. Bladder neck division/closure and collagen injections are reliable secondary options for achieving continence.
Area of Science:
- Pediatric Urology
- Pediatric Surgery
- Urologic Reconstruction
Background:
- Achieving urinary continence is a critical goal for children with neurogenic and/or anatomical voiding dysfunction.
- Lower urinary tract reconstruction plays a vital role in managing these complex conditions.
Purpose of the Study:
- To review the experience with continence procedures in pediatric lower urinary tract reconstruction.
- To evaluate the success rates of various primary and secondary continence procedures.
Main Methods:
- Retrospective review of pediatric patients undergoing continence procedures since July 1993.
- Analysis of diagnoses, primary/concomitant procedures, and success rates.
- Evaluation of secondary procedures for primary failures, defining success as 4-hour dry intervals.
Main Results:
- 49 continence procedures were performed in 43 patients with diagnoses including myelomeningocele, exstrophy, and spinal cord injury.
- Initial success rates varied: bladder neck division/closure (100%), urethral sling (78%), Young-Dees-Leadbetter (79%). Primary collagen injection had a low success rate (20%).
- Secondary procedures (collagen injection, bladder neck division/closure) were successful in all cases of primary failure.
Conclusions:
- Multiple lower urinary tract procedures can achieve successful continence in pediatric patients.
- Bladder neck division/closure and collagen injection are effective secondary procedures for managing primary failures.
- Primary collagen injection demonstrated a low success rate in this cohort.
Purpose:
Achieving continence remains a major goal in the treatment of children with neurogenic and/or anatomical voiding dysfunction. We reviewed our experience with continence procedures in pediatric lower urinary tract reconstruction.
Materials And Methods:
We reviewed the records of all pediatric patients who underwent continence procedures at our institution since July 1993. We reviewed the diagnosis, type of primary reconstructive procedure, concomitant procedure(s) and initial success rate. In cases of primary failure we noted the type of secondary continence procedure performed and the ultimate success rate. Success was defined as dry intervals of at least 4 hours when the patient was compliant with a catheterization or voiding regimen.
Results:
Primary continence procedures were performed in 43 cases and secondary procedures were performed in 6 for a total of 49 continence procedures. The diagnoses included myelomeningocele in 22 patients, exstrophy in 12, epispadias in 3, bilateral single system ureteral ectopia in 3 and spinal cord injury in 3. A total of 32 primary procedures were performed concomitantly with or were preceded by bladder augmentation with creation of a catheterizable stoma. The remaining 11 patients underwent a continence procedure only. The diagnosis in these 11 patients was exstrophy in 5, epispadias in 3, with spinal cord injury in 2 and myelomingocele in 1. Mean followup was 35 months (range 1 to 95). Initial continence procedures included Young-Dees-Leadbetter bladder neck repair in 14 cases, of which 11 (79%) were initially successful, a urethral sling in 9 with 7 initial successes (78%), bladder neck division and closure in 7 with all successful (100%), collagen in 5 with 1 success (20%), other urethral lengthening procedure (eg Pippi Salle or Kropp) in 4 with 3 successes, (75%), combined urethral sling and Young-Dees-Leadbetter in 2 with 1 success (50%), and an artificial sphincter and fascial wrap in 1 each, which were successful. Of the 6 secondary procedures performed for primary failure collagen was injected in 4 and the bladder neck was divided and closed in 2. All were successful.
Conclusions:
Various lower urinary tract procedures can be performed to achieve successful continence in the pediatric population. At our institution all procedures had a reasonable success rate except primary collagen injection. Collagen injection and bladder neck division/closure proved to be reliable secondary procedures in cases of primary failure.