An Evaluation of the Effectiveness of External Urethral Meatus Incision in Girls with an Anterior Deflected Urinary Stream and Symptoms of Detrusor Overactivity

Abstract

Background. Urethral stenosis or abnormalities in the external urethral meatus in girls may lead to serious functional bladder outlet obstruction and recurrent urinary tract infections. Objectives. The aim of the study was to analyze the efficacy of meatotomy in girls with an anterior deflected urinary stream (AdUS) and symptoms of detrusor overactivity. Material and Methods. A group of 67 girls between the ages of 5 and 16 (mean age: 8.6 years) with symptoms of detrusor overactivity participated in the study. The girls were treated with oxybutinin in the years 2010−2011. The group included 37 girls with AdUS (the AdUS group) while the remaining 30 girls (the OXY group) were found to have a normal urinary stream. In the AdUS group an external urethral meatus incision was performed. The follow-up period was three months. The presence of urinary tract infections (UTI) as well as nocturnal bedwetting and daytime incontinence were analyzed before and after treatment. Results. After three months, in the AdUS group no UTI was found in 12 children (32%) (p < 0.05), including 11 patients with prior febrile UTI (p < 0.05). Recovery from daytime urinary incontinence was observed in 20 girls (54%) and recovery from nocturnal bedwetting in 8 girls (22%). In the OXY group no infections were found in three girls (10%); recovery from daytime urinary incontinence was noted in 21 girls (70%) and from nocturnal bedwetting in 10 girls (33%). Conclusions. Girls with symptoms of detrusor overactivity accompanied by an anterior deflected urinary stream experience UTIs and fever more often than girls with detrusor overactivity and a normal urinary stream. An incision in the external urethral meatus in girls with AdUS and detrusor overactivity seems to be effective treatment for recurrent urinary tract infections, especially febrile ones (Adv Clin Exp Med 2014, 23, 2, 283-287).

The effect of meatal correction on daytime urinary incontinence in girls with an anterior deflected urinary stream

“…To achieve this, they tend to assume a hovering position while voiding, making proper relaxation of the pelvic floor muscles more difficult (2). It is therefore thought that functional voiding disorders may be triggered by the experienced inability to void in the ideal toileting posture, causing a functional bladder outlet obstruction (2,3).…”

Ivabradine inhibits carbachol-induced contractions of isolated rat urinary bladder

“…5 Overactive bladder is a very common chronic condition that affects the daily lives of a huge number of men, women and children worldwide. 5,6 Urinary urgency, frequent urination and nocturia are a common set of OAB symptoms that can be caused by a wide range of conditions, including detrusor hyperreflexia, urinary tract infections and obstructive prostatic hypertrophy. 5,6 Whatever the underlying cause, intense and involuntary bladder muscle contractions are present.…”

“…5,6 Urinary urgency, frequent urination and nocturia are a common set of OAB symptoms that can be caused by a wide range of conditions, including detrusor hyperreflexia, urinary tract infections and obstructive prostatic hypertrophy. 5,6 Whatever the underlying cause, intense and involuntary bladder muscle contractions are present. Although symptoms can range in severity from mild to very severe, OAB is a condition that often requires treatment.…”