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The use of rectus fascia to manage urinary incontinence
S B Bauer1, C A Peters, A H Colodny
1Division of Urology, Children's Hospital, Boston, Massachusetts.
Insights
The rectus fascial sling is a viable surgical option for treating pediatric urinary incontinence, especially in girls with neurogenic bladder dysfunction. This procedure improved continence in 8 of 11 patients, offering a solution when other treatments fail.
Area of Science:
- Pediatric Urology
- Female Pelvic Medicine
- Reconstructive Surgery
Background:
- Pediatric urinary incontinence presents significant management challenges.
- Established treatments like medication and catheterization often fail.
- Complex cases require advanced surgical interventions.
Purpose of the Study:
- To evaluate the efficacy of the rectus fascial sling procedure for urinary incontinence in pediatric female patients.
- To analyze the urodynamic findings contributing to persistent incontinence.
- To assess long-term outcomes of surgical management.
Main Methods:
- Retrospective review of 11 girls (6-22 years) with refractory urinary incontinence.
- Patients had diagnoses including neurogenic bladder, surgical injury, or urogenital sinus abnormality.
- Urodynamic studies were performed to assess urethral resistance and bladder function.
Main Results:
- Eight of eleven patients achieved dryness postoperatively (3-24 months) with intermittent catheterization.
- Postoperative urodynamics showed improved urethral resistance during bladder filling and increased abdominal pressure.
- Three patients had partial or no improvement, indicating varied responses to the sling procedure.
Conclusions:
- The rectus fascial sling is a promising surgical alternative for selected female pediatric patients with refractory urinary incontinence.
- Improved outlet resistance is a key factor in the success of the rectus fascial sling.
- Further research can refine patient selection and surgical techniques for optimal outcomes.
Abstract:
The surgical management of urinary incontinence in children is one of the most difficult challenges facing pediatric urologists today. We have critically looked at our experience using a rectus fascial sling to prevent incontinence. Eleven girls (6 to 22 years old) with urinary incontinence from neurogenic bladder dysfunction (9), surgical injury to the bladder (1) or urogenital sinus abnormality (1) comprise this study. All had failed regimens of pharmacological therapy and intermittent catheterization. Three patients had undergone prior bladder neck reconstruction and 2 an augmentation cystoplasty in an attempt to control the incontinence. Urodynamic studies revealed several reasons for the continued wetting in these individuals: a changing neurological lesion leading to a loss of innervation and concomitantly lowered urethral resistance in 2 patients, adequate urethral resistance at rest but decreasing resistance with bladder filling in 4, no increase in urethral resistance with increases in abdominal pressure in 4 and urethral instability (a decrease in resistance following a cough or Valsalva's maneuver) in 1 apparently neurologically normal girl. Eight patients are dry 3 to 24 months postoperatively on intermittent catheterization. All have demonstrated either an increase in urethral resistance at rest or an adequate level of resistance during filling of the bladder or a sudden increase in abdominal pressure. Of the remaining 3 patients 1 is dry for 2 to 3 hours but then leakage occurs, 1 is improved but damp and 1 patient is wet 3 months postoperatively. The use of rectus fascia to improve outlet resistance seems to be a viable alternative in the management of incontinence in selected female subjects.