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Bladder exstrophy-epispadias complex: The effect of urotherapy on incontinence
Frank-Jan van Geen1, Anka J Nieuwhof-Leppink2, Ruud C Wortel3
1Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
Intensive urotherapy improved incontinence in most children with bladder exstrophy-epispadias complex (BEEC) after surgery. This conservative approach enhances continence and social acceptance, even when complete dryness isn't achieved.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Urotherapy
Background:
- Urinary continence is a primary goal for children with bladder exstrophy-epispadias complex (BEEC).
- Surgical treatments often yield moderate success and can negatively impact quality of life.
- Conservative options like intensive urotherapy warrant earlier consideration for BEEC patients with persistent incontinence.
Purpose of the Study:
- To evaluate the effectiveness of an intensive urotherapy program for managing incontinence in children with BEEC post-reconstructive surgery.
- To assess the impact of urotherapy on continence rates and social acceptability.
Main Methods:
- A retrospective chart review of children undergoing an intensive, inpatient urotherapy program for persistent incontinence after BEEC reconstructive surgery.
- The program involved a ten-day cognitive behavioral therapy-based training with intensive follow-up.
- Continence was measured by complete dryness or a significant reduction in wet days.
Main Results:
- Out of 33 patients (mean age 10.6 years), 61% achieved improved or complete continence after urotherapy.
- Children with classic bladder exstrophy showed higher success rates (81%) compared to those with epispadias (38%).
- 75% of patients with residual incontinence reported it as socially acceptable.
Conclusions:
- Intensive urotherapy is effective in improving continence or achieving complete dryness in the majority of BEEC patients post-surgery.
- The program positively impacts the social acceptance of persistent incontinence.
- Conservative urotherapy should be prioritized over repeated surgeries due to its efficacy and positive impact on quality of life.
Introduction:
Achieving urinary continence is a key goal in children born with the bladder exstrophy-epispadias complex (BEEC). Unfortunately, this goal is only moderately achieved despite sometimes extensive surgical treatment. Undergoing repeated hospitalization and operations may consequently have a negative impact on quality of life. We therefore believe that other, conservative treatment options should be explored in an earlier stage of incontinence treatment in BEEC patients. As part of this, an intensive urotherapy program based on was offered to patients with persistent incontinence after reconstructive surgery for BEEC.
Objective:
The aim of this study is to evaluate the benefits of intensive urotherapy on incontinence after reconstructive surgery in children with BEEC.
Study Design:
A retrospective chart study was performed including all children who were enrolled in an intensive urotherapy program because of persistent incontinence after reconstructive surgery for BEEC. Urotherapy consisted of a ten-day inpatient training program based on cognitive behavioral therapy, with intensive follow-up by experienced urotherapists. Main outcome measurement was continence, expressed as the percentage of children that achieved complete continence (good result; 100% dry) or 50-99% decrease of wet days a week (improved result) after treatment.
Results:
Data of 33 patients with a mean age of 10.6 years were analyzed. In 61% of cases (20/33) an improved or good result was reported on incontinence after urotherapy. Children with classic bladder exstrophy more often achieved a good or improved result (13/16; 81%), compared to children with epispadias (6/16; 38%). The only patient with a cloacal exstrophy completed treatment with an improved result. From the group of patients with persistent incontinence, 75% (12/16) reported that the complaints were socially acceptable at the end of follow-up.
Discussion:
By following our intensive urotherapy program the majority of patients achieved complete continence or improved incontinence. In addition, our results show that the inpatient training program has a positive impact on acceptance in cases of persistent incontinence. The urotherapists offer individualized care and clear guidance, which we deem essential elements of successful treatment. Considering that repeated surgery may impede progress and offers no guarantee of continence, we recommend giving preference to conservative treatment options.
Conclusion:
Our results show that 37% (12/33) of patients with BEEC who were enrolled in our intensive urotherapy program because of persistent incontinence after reconstructive surgery, achieved complete continence after urotherapy and 63% (21/33) still experienced some degree of incontinence. 75% of patients who did not achieve complete continence, described the remaining incontinence as socially acceptable. These findings strongly support counselling patients with BEEC to consider conservative treatment before opting for further surgery.
