Bladder neck sling and appendicovesicostomy without augmentation for neurogenic incontinence in children

Most children undergoing bladder neck sling for neurogenic urinary incontinence also have undergone bladder augmentation. However, complications from enterocystoplasty and uncertainty regarding its indication during bladder outlet enhancement led us to perform slings without augmentation. Herein we report outcomes in consecutive patients.

A total of 30 patients with neurogenic bladder underwent tight 360-degree fascial sling wrap around the bladder neck and appendicovesicostomy without augmentation. Indications included detrusor leak point pressure less than 50 cm water and stress urinary incontinence. Urodynamics were obtained in all patients preoperatively, in 26 at a mean of 6 months postoperatively and in 16 at a mean of 24 months postoperatively.

Satisfactory continence defined as 2 or fewer damp pads daily was achieved in 83% of patients with followup of 6 to 60 months (mean 22). Symptomatic hyperreflexia and/or loss of compliance developed in 8 patients postoperatively, which responded to anticholinergics in 7. The remaining patient underwent enterocystoplasty 18 months later, for an augmentation rate of 3%. No patient had hydronephrosis or reflux.

Evaluated parameters, including bladder capacity and compliance determined during preoperative urodynamics, did not predict the need for augmentation. Satisfactory continence can be achieved for neurogenic bladder by sling without enterocystoplasty.