Pediatric urology

Abstract

This is a valuable paper for the interested in female urology. It is notable that the incidence of post operative urinary urge incontinence was similar in both the surgical group of patients who had preoperative urinary urge incontinence and the control group who had no preoperative urinary urge incontinence. Also of specific interest is that though the patients who preoperatively complained of urinary urge incontinence had negative cystometrograms, 9 of 10 patients had cystometric evidence of detrusor overactivity when plagued with postoperative urinary urge incontinence. In addition, other noteworthy urodynamic changes noted in the study group was a diminution in the maximum flow rate in the patients who had persistent urinary urge incontinence. The authors through their documentation of these urodynamic parameters and their noted difference in the pre-and post-operative patients raised a valuable point: is the etiology of preoperative urinary urge incontinence different from the etiology of postoperative urinary urge incontinence? The authors lead us to believe that this is definitely possible with postoperative urinary urge incontinence potentially being related to an infravesical outlet obstruction as opposed to a preoperative idiopathic condition.The discussion section by Dr. Osman is of great value and warrants careful reading both for the facts, which it presents as well as the questions that it raises with regard to the etiology of this most troublesome malady. It would be of genuine interest if the author could expand on the urodynamic differences pre and postoperatively between the group that underwent a Burch urothropexy vs. those who underwent a suburethral pubovaginal sling secondary to the historical claim of the potentially obstructive nature of a suburethral sling.In conclusion, the paper's findings are along the same line as those voiced by Dr. McGuire in the past in that the finding of detrusor instability on a preoperative cystometrogram does not preclude a good result (1). Interested readers should consider other landmark papers of great value on this topic (1,2).