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Open and Laparoscopic Colposuspension in Girls with Refractory Urinary Incontinence
Barbara Anna Dobrowolska-Glazar1, Luitzen A Groen2,3, Anka J Nieuwhof-Leppink3
1Department of Pediatric Urology, Jagiellonian University Medical College UCHC, Krakow, Poland.
Insights
Open and laparoscopic colposuspension are effective surgical options for treating refractory urinary incontinence in children with bladder neck insufficiency when conservative methods fail. Both techniques demonstrate comparable success rates in improving symptoms.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Lower Urinary Tract Symptoms Management
Background:
- Lower urinary tract symptoms (LUTS) are prevalent in children, with standard treatments including urotherapy and medication.
- A subset of girls experiences stress or stress-induced urge incontinence.
- Congenital bladder neck insufficiency (BNI) may necessitate surgical intervention for persistent LUTS.
Purpose of the Study:
- To evaluate the outcomes of open and laparoscopic colposuspension in pediatric patients with refractory urinary incontinence (UI).
- To compare the efficacy and results of two surgical approaches for BNI.
Main Methods:
- A comparative analysis of 18 open and 18 laparoscopic colposuspensions in children with UI who failed conservative management.
- Diagnosis of BNI confirmed via perineal ultrasound and video-urodynamic studies.
- Laparoscopic procedures were performed preperitoneally; open procedures used a transverse lower abdominal incision.
Main Results:
- Mean operative time was shorter for open colposuspension (65 min) compared to laparoscopic (90 min) (p < 0.05).
- Full success rates were 7/18 for open and 8/18 for laparoscopic procedures; partial response was observed in 3/18 and 5/18, respectively (p = 0.64).
- No intraoperative complications were reported in either group.
Conclusions:
- Both open and laparoscopic colposuspension are viable surgical treatments for refractory pediatric urinary incontinence secondary to BNI.
- These surgical interventions offer effective solutions when non-invasive treatments are unsuccessful.
Introduction:
Lower urinary tract symptoms (LUTS) are very common in children. Standard treatments consist of urotherapy, antibiotic prophylaxis, anti-muscarinics, physical therapy, and the treatment of coexisting constipation. A small group of girls also present with stress incontinence or with stress-induced urge incontinence. In cases of persistent LUTS due to congenital bladder neck insufficiency (BNI), surgical treatment might be considered. The aim of this paper is to assess the results of open and laparoscopic colposuspension in children with refractory urinary incontinence (UI).
Materials And Methods:
The results of 18 open and 18 laparoscopic consecutive colposuspensions were analyzed. All patients had UI and failed conservative treatment. BNI was proven by repeated perineal ultrasound and video-urodynamic study. The laparoscopic procedure was performed preperitoneally and the open procedure was via a transverse lower abdominal incision. The same postoperative protocol was used in both groups.
Results:
The mean operation time was 65 min for the open and 90 min for the lap procedure (p < 0.05). Full success was achieved in 7/18 in the open and in 8/18 in the lap group and partial response was seen in 3/18 and in 5/18, respectively (p = 0.64). No intraoperative complications occurred in this cohort.
Conclusion:
Open and laparoscopic colposuspension can be used to treat refractory UI in children with BNI when non-invasive methods fail.
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