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Endoscopic treatment for urinary incontinence in children with a congenital neuropathic bladder
M Silveri1, M L Capitanucci, G Mosiello
1Paediatric Surgery Department, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy.
Insights
Endoscopic collagen injection improved urinary incontinence in children with neurogenic bladder, particularly those with detrusor areflexia and good bladder compliance. Patient selection and increased injection volume can enhance outcomes.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Neurogenic bladder and urinary incontinence significantly impact children's quality of life.
- Endoscopic collagen injection is a treatment option for refractory cases.
Purpose of the Study:
- To evaluate the effectiveness of endoscopic collagen injection for neurogenic urinary incontinence in children.
- To identify factors influencing treatment success.
Main Methods:
- Retrospective analysis of 23 children (mean age 10.9 years) with neurogenic urinary incontinence treated with endoscopic collagen injections.
- Preoperative urodynamic evaluation (cystometry) to assess bladder function.
- Analysis of 'dry' interval, patient/parent satisfaction, and procedure details.
Main Results:
- 13 of 23 patients showed improvement in dryness (at least 2-hour increase in 'dry' interval).
- Success was associated with detrusor areflexia and good bladder compliance.
- No significant difference in outcomes was observed based on surgical experience (early vs. late procedures).
Conclusions:
- Urodynamic patient selection (detrusor areflexia, good compliance) is crucial for successful endoscopic collagen injection.
- Increasing injected material volume and longer follow-up may improve outcomes.
- Close postoperative monitoring is essential for optimizing treatment strategy.
Objective:
To verify, in a retrospective analysis, the effectiveness of endoscopic treatment (collagen injection) in children with neurogenic bladder and neurogenic urinary incontinence.
Patients And Methods:
From January 1992 to March 1997, 36 endoscopic collagen injections were performed to treat neurogenic urinary incontinence in 23 patients (mean age 10.9 years, range 6-17 at the time of the first procedure) selected on the basis of clinical status and the patient's motivation. Nineteen patients were affected by myelomeningocele and four had an occult spinal dysraphism. All patients underwent a preoperative cystometric urodynamic evaluation (without urethral pressure measurement) which showed detrusor areflexia in 12, normal reflexia in one and hyper-reflexia in 10 patients. Bladder compliance was considered good (> or =20 cmH2O) in 13 patients and low (10-20 cmH2O) in 10, four of whom had detrusor areflexia. Twenty-one children emptied their bladder by intermittent clean catheterization. The mean (range) follow-up was 19.2 (6-54) months. Twenty (group A) and 16 (group B) procedures, performed early and late in the series, were analysed separately to determine any increase in effectiveness with surgical experience. The evaluation criteria were; the increase in the 'dry' interval (between catheterizations) before and after treatment/s (delta dry); the patient's and parent's satisfaction; the number of endoscopic procedures and quantity of injected materials.
Results:
There was an improvement (dryness of at least 2 h: delta dry of 1 h) in 13 of 23 patients after 1-3 (mean 1.5) procedures; 10 patients had a 0.2 h increase in delta dry after 1-3 injections and none was satisfied. There was no difference in the delta dry (0.9 vs. 0.7 h) between groups A and B, and/or the patient's/parent's satisfaction. Success rates differed with urodynamic patterns; seven of 10 patients showing no improvement had hyper-reflexia and three of the remaining 12 with areflexia had hypocompliant bladders, while nine of the 13 showing improvement had an areflexic detrusor and low-pressure bladders.
Conclusion:
The efficacy of the treatment depends largely on the urodynamic selection of patients (mainly those with detrusor areflexia and good compliance). The outcome may be improved further by increasing the quantity of injected material and with a longer follow-up, performing the procedure again if advisable. A close postoperative clinical (pad test) and personal observation is necessary to evaluate the outcome and thus optimize the strategy of treatment.