Treating neuropathic incontinence in children with seromuscular colocystoplasty and an artificial urinary sphincter

Abstract

Purpose To review the results of artificial urinary sphincter (AUS) implantation combined with seromuscular colocystoplasty (SCLU) in the treatment of mixed neurogenic urinary incontinence in children. Patients and methods Patients (27, six females) who had undergone SCLU were interviewed, and their charts and imaging studies reviewed retrospectively. Their urodynamic data were analysed and bladder capacity, end-filling pressure, safe capacity and percentage of expected capacity for age compared before and after surgery. Continence was defined as dryness between catheterizations or voiding with no need for protective pads. Results The mean ( SD ) follow-up since the SCLU was 1.7 (1.1) years; continence was achieved in 24 of the 27 (89%) patients with no additional procedures. No significant upper tract changes developed. Bladder capacity, safe capacity for age and end-filling pressure were all improved significantly. There were two AUS erosions necessitating removal and in one patient the augmentation failed. Six patients early in the series developed an 'hourglass' deformity that required correction. Modifications to the technique to avoid this complication are discussed. Conclusions For children with neuropathic incontinence who require both augmentation of outlet resistance and bladder storage capacity, the combination of the AUS and SCLU effectively achieves continence with no upper tract deterioration. SCLU is also the preferred method of augmentation when adverse bladder changes occur after implanting the AUS.

Surgical Management of Neurogenic Sphincter Incompetence in Children

“…Nevertheless, it is questionable which urodynamic parameters are important to determine the need for augmentation (74, 75). In an attempt to reduce the likelihood of intestinal augmentation related complications others have combined the implantation of AUS with a seromuscular colocystoplasty with more than 85 % dryness at 2 years (76, 77). Others have sought to avoid the potential complications of mechanical malfunction of the AUS by implanting only the cuff at the time of an enterocystoplasty but most patients eventually required implantation of the entire AUS system (78).…”

Alternatives to Conventional Enterocystoplasty in Children: A Critical Review of Urodynamic Outcomes

“…Also the procedure works best in patients with high outlet resistance to prevent early urine leak around the catheter, for example those who have an artificial urinary sphincter or a sling implanted prior or at the time of the augmentation (52). Preoperative measures of leak point pressure are no always reliable as the detrusorectomy can cause a drop in outlet resistance (38).…”

Hourglass urinary bladder in a spinal cord injury patient - unusual late complication of suprapubic cystostomy: a case report

“…Hourglass deformity of bladder has been described following seromuscular colocystoplasty in the treatment of mixed neurogenic urinary incontinence in children [4], and in patients who underwent bladder autoaugmentation to treat neuropathic bladder secondary to myelomeningocele [5]. Very rarely hourglass bladder may be a congenital deformity [6].…”