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Management of urinary incontinence in neurogenic bladder
1Department of Paediatric Surgery, Addenbrooke's Hospital, Cambridge, UK.
Insights
Treating pediatric neurogenic bladder incontinence is challenging. Clean intermittent catheterization (CIC), often combined with urethral lengthening, is a key method for achieving dryness in girls.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Neurogenic bladder in children poses significant treatment challenges for pediatric urologists.
- A large cohort of 527 patients with neurogenic bladder was managed between 1965 and 1989.
- Treatment options included continent cystostomy, artificial urinary sphincter, and clean intermittent catheterization (CIC).
Purpose of the Study:
- To evaluate the effectiveness of various treatments for pediatric neurogenic bladder.
- To highlight the importance of CIC, particularly in female patients.
- To present a technique for urethral lengthening (Kropp's procedure) as an adjunct to CIC.
Main Methods:
- Retrospective analysis of 527 pediatric patients with neurogenic bladder treated from 1965 to 1989.
- Specific focus on 177 patients managed with clean intermittent catheterization (CIC).
- Detailed description of the urethral lengthening (Kropp's procedure) technique.
Main Results:
- Clean intermittent catheterization (CIC) is crucial for managing urinary incontinence in girls.
- CIC can be enhanced with complementary procedures for poor urethral resistance or bladder compliance.
- Urethral lengthening combined with CIC offers a significant solution for achieving dryness in girls.
Conclusions:
- Clean intermittent catheterization (CIC) is a vital treatment modality for pediatric neurogenic bladder incontinence.
- Urethral lengthening (Kropp's procedure) is an effective complementary technique for improving outcomes in girls.
- The study discusses the role of CIC within the broader context of incontinence management strategies.
Abstract:
The treatment of children with urinary incontinence caused by a neurogenic bladder presents a challenge to the paediatric urologist. Between 1965 and 1989, 527 patients with neurogenic bladder were treated and followed-up in the Department of Paediatric Urology of Debrousse Hospital. Of these, 46 were submitted to continent cystostomy, 39 to urinary artificial sphincter and 177 to clean intermittent catheterization (CIC). This last treatment is of paramount importance in girls and can be associated with complementary procedures if cervico-urethral resistance and/or bladder compliance are poor. Urethral lengthening (Kropp's procedure) in combination with CIC represents a major means of providing dryness in girls. Our technique of urethral lengthening is detailed and the place of CIC among other incontinence treatment is discussed.