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Expanded PTFE bladder neck slings for incontinence in children: the long-term outcome
1Department of Paediatric Urology, Sheffield Children's NHS Trust, Sheffield, UK. prasadgodbole@btinternet.com
Insights
Expanded polytetrafluoroethylene (Gore-Tex) bladder neck slings showed short-term success for pediatric neuropathic bladder incontinence but led to long-term complications, necessitating removal in most cases due to erosion and calculus formation.
Area of Science:
- Pediatric Urology
- Urologic Surgery
- Biomaterials in Medicine
Background:
- Neuropathic bladder in children often presents challenges with urinary incontinence.
- Previous treatments like clean intermittent catheterization and pharmacotherapy can fail.
- Bladder neck slings are a surgical option to improve urethral continence.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of circumferential expanded polytetrafluoroethylene (Gore-Tex) bladder neck slings.
- To assess the durability of continence achieved by this surgical technique in pediatric patients.
- To identify potential complications associated with Gore-Tex slings in the long term.
Main Methods:
- Retrospective review of 19 pediatric patients with neuropathic bladder undergoing Gore-Tex sling placement.
- Patients had failed conservative management and presented with low urethral leak-point pressure.
- Follow-up focused on achieving dryness, maintaining catheterization, and identifying complications.
Main Results:
- Initial short-term continence was achieved in most patients.
- At a median follow-up of 7 years, 14 out of 17 patients required sling removal due to erosion.
- Erosion was frequently associated with bladder calculus formation and transient urethral leakage.
Conclusions:
- Circumferential Gore-Tex bladder neck slings offer favorable short-term results for pediatric neuropathic bladder incontinence.
- The technique is not a useful long-term solution due to high rates of erosion and associated complications.
- Alternative strategies may be necessary for durable urethral continence in this patient population.
Objective:
To assess the long-term outcome of circumferential expanded PTFE (Gore-tex, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder.
Patients And Methods:
The records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore-tex sling placed circumferentially at the bladder neck, over a 5-year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak-point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization.
Results:
Full details of the follow-up were available in 17 patients. Despite initial good short-term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one.
Conclusion:
Although in the short term this technique had favourable results, it was not a useful technique in the long term.