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Bladder-outlet reconstruction in neurogenic bladder due to myelomeningocele
H W Johnson1, P F Weckworth, G U Coleman
1Department of Surgery (Urology), University of British Columbia, Vancouver.
Insights
Bladder-outlet reconstruction improved urinary incontinence in children with myelomeningocele, with higher success rates in girls than boys. Further research into artificial sphincters for boys is suggested.
Area of Science:
- Pediatric Urology
- Neurosurgery
- Reconstructive Surgery
Background:
- Myelomeningocele often leads to refractory urinary incontinence.
- Standard treatments like clean intermittent catheterization and anticholinergic medication are insufficient for some children.
- Bladder-outlet reconstruction is a surgical option for intractable urinary incontinence in this population.
Purpose of the Study:
- To evaluate the outcomes of bladder-outlet reconstruction in children with myelomeningocele and refractory urinary incontinence.
- To compare the efficacy of different surgical procedures between boys and girls.
Main Methods:
- Retrospective review of 24 children with myelomeningocele requiring bladder-outlet reconstruction.
- Procedures included Young-Dees/Leadbetter, Burch procedure, or a combination.
- Augmentation cystoplasty was performed in select cases.
- Outcomes were assessed based on improvement in urinary incontinence.
Main Results:
- Overall improvement in urinary incontinence was observed.
- Girls undergoing the Burch procedure showed a 92% improvement rate.
- Boys undergoing the Young-Dees/Leadbetter procedure had a 58% improvement rate.
- Augmentation cystoplasty was performed in 8 patients (7 girls, 1 boy).
Conclusions:
- Bladder-outlet reconstruction is effective for managing refractory urinary incontinence in children with myelomeningocele.
- Surgical outcomes are more favorable in girls compared to boys.
- Artificial sphincter placement may be a more beneficial alternative for boys with this condition.
Abstract:
In a subgroup of children with myelomeningocele, urinary incontinence cannot be managed by clean intermittent catheterization and anticholinergic medication. The authors report on 24 such children who required bladder-outlet reconstruction. Twelve boys underwent the Young-Dees/Leadbetter procedure, 8 girls underwent the Burch procedure and the remaining 4 had a combination of the two. Augmentation cystoplasty was also carried out in seven girls and one boy. Results were most favourable in the girls, with improvement in 92%, in contrast to the boys in whom only 58% were improved. Artificial sphincter placement may be a more beneficial alternative for boys.