Myofascial wrap to treat intractable urinary incontinence in children
M E Kolligian1, L S Palmer, E Y Cheng
1Division of Urology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
The myofascial wrap effectively treats intractable urinary incontinence in children with complex urogenital conditions. This surgical technique provides support and tone to the bladder neck, leading to successful continence in most patients.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Intractable urinary incontinence in pediatric patients with conditions like bladder exstrophy presents significant management challenges.
- Previous surgical interventions such as bladder neck plasty or augmentation cystoplasty may fail, necessitating alternative treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of the myofascial wrap, a modified rectus fascial wrap, in managing intractable urinary incontinence in pediatric patients.
- To assess the myofascial wrap's ability to provide support, mucosal coaptation, and active muscular tone to an incompetent bladder neck.
Main Methods:
- The study involved eight pediatric patients (5 female, 3 male) with total urinary incontinence due to sphincteric incompetence.
- The myofascial wrap procedure utilizes a full-thickness, vascularized pedicle of rectus sheath and muscle, wrapped around the bladder neck.
- The wrap is secured to the pubic bone, aiming to restore bladder neck support and function.
Main Results:
- Six out of eight patients achieved complete urinary continence following the myofascial wrap procedure.
- The remaining two patients were able to void spontaneously without requiring catheterization.
Conclusions:
- The myofascial wrap is a valuable surgical option for pediatric patients with intractable urinary incontinence and sphincteric incompetence.
- The procedure successfully restores support, mucosal coaptation, and muscular tone to the bladder neck, yielding favorable outcomes in a challenging patient population.
Objectives:
The management of intractable urinary incontinence in the patient with cloacal or bladder exstrophy/epispadias, failed bladder neck plasty, or failed augmentation cystoplasty remains a surgical challenge. The myofascial wrap, a modification of the rectus fascial wrap, was developed to treat intractable urinary incontinence due to sphincteric incompetence in these problematic cases. A full-thickness, vascularized pedicle of anterior rectus sheath, rectus abdominis muscle, and posterior rector sheath is incorporated into a bladder neck wrap to provide support, mucosal coaptation, and active muscular tone.
Methods:
Eight patients (5 females and 3 males) with total urinary incontinence due to sphincteric incompetence underwent the myofascial wrap. Urinary tract pathology included cloacal exstrophy (2), female epispadias (2), classic bladder exstrophy (1), male epispadias (1), myelomeningocele (1), and a pelvic tumor (1). The procedure is performed by harvesting a full-thickness strip of pedicled rectus muscle along with the anterior and posterior fascial sheaths. The strip is passed underneath and then over the bladder neck in a near 360 degrees wrap. The free end of the wrap is anchored into the pubic bone in an ipsilateral subperiosteal pouch.
Results:
Six of the 8 patients are completely continent, and 2 patients void spontaneously without the need for catheterization.
Conclusions:
The myofascial wrap provides support, mucosal coaptation, and muscular tone to an incompetent sphincter and bladder neck. Favorable results in a very difficult population of pediatric patients warrant its continued use.
