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Urethral lengthening and reimplantation: incidence and management of catheterization problems
P R Waters1, N C Chehade, K A Kropp
1Department of Urology, Medical College of Ohio, Toledo.
Insights
Most children with intractable urinary incontinence achieve dryness after urethral lengthening and reimplantation. Catheterization difficulties are uncommon and manageable with simple interventions, preserving surgical goals.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Intractable urinary incontinence in children often necessitates surgical intervention.
- Urethral lengthening and reimplantation with a catheterizable valve aims to achieve dryness.
Purpose of the Study:
- To document the incidence, time course, and management of catheterization problems in children undergoing urethral lengthening and reimplantation for intractable incontinence.
Main Methods:
- Retrospective review of 49 children (21 boys, 28 girls) who underwent urethral lengthening and reimplantation between 1982 and 1995.
- Catheterization problems defined as inability to pass the catheter, categorized into early, late, recurrent, and persistent issues.
Main Results:
- 72% of patients experienced no catheterization difficulties.
- 14% had recurrent problems, and 4% had persistent issues requiring alternate bladder access.
- Difficulties, when present, were often managed by changing catheter type or technique, with most cases resolved.
Conclusions:
- The majority of children undergoing this procedure do not experience catheterization problems.
- When catheterization difficulties arise, minimally invasive treatments are effective and do not compromise the original surgical objectives.
Purpose:
Creation of a 1-way catheterizable valve has resulted in dryness for a large group of children with intractable urinary incontinence. We document the incidence, time course and management of catheterization problems in 49 children who underwent urethral lengthening and reimplantation for intractable incontinence.
Materials And Methods:
We reviewed the records of 21 boys and 28 girls who underwent urethral lengthening and reimplantation between 1982 and 1995. Catheterization problems were defined as the inability of the patient or a family member to pass the catheter, and divided into early only, late only, recurrent and persistent problems.
Results:
Of the 49 patients 46 had neurogenic incontinence secondary to myelomeningocele and 35 (72%) never had difficulty catheterizing. Of the 14 children (28%) who had difficulty 7 (50%) were boys and 7 (50%) were girls. Two children (4%) with early only difficult catheterization have had no further difficulties during the last 14 and 6 years, respectively. In 3 children (6%) late only difficult catheterization began 17, 24 and 35 months, respectively, after the original bladder neck surgery. These problems were solved by changing to a Coudé catheter and/or avoiding over distension. The 7 patients (14%) with recurrent catheterization problems, some with long intervals between episodes, now catheterize easily. The 2 children (4%) with persistent problems required alternate access to the bladder.
Conclusions:
The majority of children (72%) who undergo urethral lengthening and reimplantation never have any difficulty catheterizing. Those in whom difficult catheterization develops can be treated with minimally invasive methods without compromising the goals of the original surgery.