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[The surgical treatment of urinary incontinence in children]
Insights
Surgical reconstruction of the neck of the urinary bladder (NUB) and uretero-cystostomy effectively treated total enuresis in children. Most patients achieved normal urinary continence after surgery, with improved bladder capacity.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Lower Urinary Tract Disorders
Background:
- Total enuresis in children often presents challenges, especially after failed conservative or operative treatments.
- Identifying the underlying cause, such as neck of urinary bladder (NUB) or urethral abnormalities, is crucial for effective management.
- Previous treatments may not address the organic nature of certain NUB lesions.
Observation:
- Eight children (aged 4-13) with total enuresis, unresponsive to prior treatments, were studied.
- Enuresis was linked to NUB or urethral issues in all patients; specifically, congenital NUB defects (4), total epispadias (1), and spina bifida (1).
- Urodynamic and electromyography studies confirmed organic NUB lesions and ruled out detrusor-sphincter dyssynergia.
Findings:
- Surgical intervention involving NUB reconstruction (Davis procedure) and bilateral uretero-cystostomy (Coen procedure) was performed on all children.
- Seven out of eight patients demonstrated immediate postoperative urine retention (40 min-2.5 hours).
- Long-term follow-up (6 months-3 years) showed sustained normal urinary continence in seven patients; one with spina bifida had persistent enuresis.
Implications:
- Surgical correction of NUB and urethral malformations offers a viable solution for refractory total enuresis in pediatric patients.
- The described surgical techniques can lead to significant improvements in urinary continence and bladder function.
- Despite partial bladder resection, bladder capacity increased post-treatment, suggesting regenerative or adaptive processes.
Abstract:
The paper reports examination, treatment and follow-up data on 8 children aged 4-13 suffering from total enuresis, who failed previous conservative or operative treatment. Upon examination enuresis was attributed to trauma or malformations of the neck of the urinary bladder (NUB) or urethra (in 2 and 6 patients, respectively). Out of the latter, NUB congenital defect was in 4, total epispadia in 1, spina bifida in 1 patient. Urodynamic studies showed the absence of detrusor-sphincter dyssynergia and confirmed organic nature of NUB lesion. Six children underwent NUB electromyography which recorded no uniform, preformed complexes with adequate voltage. All the children were operated on: NUB reconstruction according to Davis, bilateral uretero-cystostomy according to Coen. An immediate postoperative response was seen in 7 children who were able to retain urine for 40 min-2.5 hours. Long-term response (6 months-3 years) was achieved in 7 children who recovered normal uresis. Total enuresis persisted in 1 patient with spina bifida. 2.5-3 years after the treatment the bladder capacity increased in spite of its resection by 1/3.
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