Bladder Neck Sling for Treatment of Neurogenic Incontinence in Children With Augmentation Cystoplasty: Long-Term Followup

Castellán, Miguel; Gosálbez, Rafael; Labbie, Andrew; Ibrahim, Emad; DiSandro, Michael

doi:10.1097/01.ju.0000157688.41223.d2

Cited by 65 publications

(27 citation statements)

References 17 publications

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“…Subsequent urethral and bladder neck damage could explain the frequency of mixed urinary incontinence, low MUP or the opening bladder neck we observed. As recently reported by Castellan et al, 20 we associated a bladder neck fascial sling to prevent the persistence of the stress component of urinary incontinence through the native urethra. Despite this procedure, three patients required additional treatment for persistent stress urinary incontinence by the native urethra.…”

Section: Discussionmentioning

confidence: 88%

“…Interestingly, they had the lowest preoperative MUP of the series and 2/3 had an opened bladder neck. Castellan et al 20 also reported seven patients with mixed neurogenic incontinence that failed after bladder neck sling associated with bladder augmentation. Continence of native urethra remains a challenging situation in female para-or quadriplegic patients, especially with a long-standing indwelling catheter.…”

Section: Discussionmentioning

confidence: 99%

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A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra

et al. 2007

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Study design: Description of a technique and prospective follow-up study.Objectives: To present and assess a perioperative strategy associated with a single-procedure surgical technique for continent cutaneous diversion in spinal cord injury (SCI) patients requiring selfcatheterization and unable to do it through the native urethra. Setting: University hospital, Paris, France. Methods: We considered SCI patients suffering from urinary incontinence related to neurogenic detrusor overactivity and/or poor bladder emptying for more than 1 year and inability to perform selfcatheterization through the native urethra. These patients including quadriplegics underwent selection for surgery by occupational therapists and neurorehabs to assess the ability to self catheterize through an abdominal stoma and to determine the optimal site to place the stoma. The surgical technique included a single procedure: aponevrotic sling in women requiring stress continence reinforcement, supratrigonal cystectomy, preserved detrusor wall flap (original description), enterocystoplasty, a catheterizable tube using either the Mitrofanoff or Young-Monti principle and Politano-Leadbetter antireflux technique. A prospective follow-up study of consecutive patients reviewed initial condition, indication, surgical technique, complications, continence, catheterizing difficulties, functional bladder capacity and serum creatinine. Results: Thirteen consecutive patients were selected for surgery. Median follow-up was 44 months. Stoma location was variable from one patient to another. All patients had a catheterizable continent stoma at last follow-up. Kidney function was preserved. Conclusion: Given these results, a multidisciplinary approach including neuro-rehabilitation practitioners and urologists performing appropriate technical solutions in highly selected SCI patients unable to catheterize native urethra provides upper urinary tract protection and continence after a single procedure.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra

et al. 2007

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“…After an average of 4.2 years, 51 of 58 patients had achieved continence after a rectus fascia BNS (87). Small intestinal submucosal bladder neck slings achieve satisfactory rates of continence (>75%) at a mean of 15 months follow up in 14/18 females and 75% of non-ambulatory males who underwent concomitant bladder augmentation and catheterizable channel.…”

Section: Bladder Neck Proceduresmentioning

confidence: 99%

Long-Term Sequela of Pediatric Bladder Reconstruction

Roth

Keenan

Cain

et al. 2015

Curr Bladder Dysfunct Rep

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Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up. IntroductionChildren with neurogenic bladders (NGB) are initially managed with clean intermittent catheterization (CIC) and anticholinergic medications in order to maintain a sizable, continent, and compliant urinary reservoir. Despite early and aggressive intervention, some patients undergo lower urinary tract reconstruction (bladder augmentation, catheterizable channel and/or bladder neck reconstruction) to protect their upper tracts and achieve continence. In a few select patients with favorable urodynamics (UDS) and low outlet resistance, a bladder neck procedure (BNP) can be performed without bladder augmentation to achieve continence. Myelodysplasia, specifically spina bifida (SB), remains the most common etiology of NGB in the pediatric population. Due to medical advances, particularly in the realm of Urology, more SB patients with bladder reconstruction are surviving into adulthood. We review current literature regarding long-term sequela of bladder reconstruction in pediatric patients with neurogenic bladder, with a primary focus on bladder augmentations for refractory NGB secondary to SB.

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“…On the other hand, it is more difficult to determine the relative contribution of the above factors in persistently incontinent patients with NB. The parameters used presently to indicate low outlet resistance include a DLPP of < 30-40 cmH 2 O, a Valsalva leak-point pressure of < 100 cmH 2 O, lack of electromyographic activity in the striated sphincter, presence of an open BN at low filling pressures in an erect position, and a clinical history suggestive of stress UI [3,[5][6][7][8][11][12][13]. These preoperative parameters are often used in combination to assess the outlet resistance, since individually; they sometimes lack reproducibility in young children and often do not correlate with the outcome of surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Despite an aggressive protocol of clean intermittent catheterization (CIC) and anticholinergics, 10-20% of children with neurogenic bladders (NB) will eventually require surgical intervention to achieve socially acceptable dryness [1]. Reports on surgical procedures for incontinent patients with NB show a high rate of concomitant augmentation cystoplasty (AC) with bladder neck procedures (BOP) [2][3][4][5]. The implication is that a combination of poor outlet resistance and abnormal bladder storage characteristics is responsible for the urinary incontinence (UI).…”

Section: Introductionmentioning

confidence: 99%

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

et al. 2007

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OBJECTIVE To evaluate whether the degree of preoperative bladder trabeculation in neurogenic bladder (NB) patients is a marker of significant outlet resistance. If so, severe trabeculation may obviate the need for concomitant bladder outlet procedure (BOP) during augmentation cystoplasty (AC). PATIENTS AND METHODS We retrospectively reviewed 48 incontinent patients with NB who had surgery. The patients were divided into two groups: group 1 (23 patients) had AC alone; group 2 (10) had AC with BOP. Children who had a BOP alone (15) were excluded from the study. Success was defined as a dry period of ≥4 h. Preoperative bladder trabeculation was classified as mild or severe. Data collected included continence status, imaging and urodynamic findings. RESULTS In group 1 patients before surgery, there was severe bladder trabeculation in 14 (61%), hydronephrosis in 13 (57%) and associated vesico‐ureteric reflux (VUR) in 16 (70%). The mean detrusor leak‐point pressure (DLPP) was 49.7 cmH2O and the bladder neck was open in nine (39%). Dryness with AC alone was achieved in 91% of group 1 patients. In group 2 patients (10 patients), there was severe bladder trabeculation in five, hydronephrosis in three, and VUR in two. The mean DLPP was 42.8 cmH2O and the bladder neck was open in eight. After surgery, eight of 10 patients achieved a dry period of 4 h. There was no significant difference between group 1 and 2 patients for age at surgery, gender, ambulatory status, hydronephrosis, degree of trabeculation, detrusor overactivity, DLPP and eventual outcome. The incidence of VUR was higher in group 1 patients (P = 0.009) and more patients in group 2 had an open bladder neck (P = 0.031). CONCLUSION Severe bladder trabeculation in incontinent patients with NB might predict an element of intrinsic outlet resistance. In this subset of patients, dryness was achieved by AC alone without further BOP. The degree of bladder trabeculation should be considered in the surgical decision‐making process for incontinent children with NB.

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Bladder Neck Sling for Treatment of Neurogenic Incontinence in Children With Augmentation Cystoplasty: Long-Term Followup

Cited by 65 publications

References 17 publications

A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra

A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra

Long-Term Sequela of Pediatric Bladder Reconstruction

Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder

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