Urethral Lengthening and Reimplantation for Neurogenic Incontinence in Children

Abstract

We describe our experience with a urethral lengthening-reimplantation operation for the correction of incontinence in 13 myelomeningocele children, 11 of whom had failed to achieve continence on a program of intermittent clean catheterization. The procedure involves lengthening the urethra by formation of a bladder tube, which is reimplanted back into the bladder through a submucosal tunnel. This procedure allows a catheter to be passed but prevents urine from leaking. All of the operated cases are included. All of the children are out of diapers and socially dry. Followup ranged from 8 to 36 months and the problems encountered are described.

Forty-five-year follow-up on the renal function after spinal cord injury

“…The classical Young-Dees-Leadbetter (188) procedure for bladder neck reconstruction in children with bladder exstrophy and the Kropp urethral lengthening (189) improved by Salle (190) are established methods to restore continence provided that intermittent catheterisation is practiced and/or bladder augmentation is performed (172,181,(189)(190)(191)(192)(193)(194)(195)(196)(197)(198)(199)(200).…”

Expanded PTFE bladder neck slings for incontinence in children: the long‐term outcome

“…Numerous bladder neck or urethral lengthening techniques have been described [1][2][3][4][5], thereby highlighting the lack of consistent success with any one procedure. We recently reported our experience with the endourethral injection of bulking agents, with a poor long-term success [8].…”

“…The descriptions of various bladder neck procedures show the lack of consistent success with any one procedure [1][2][3][4][5]. We previously described our experience with expanded PTFE (Gore-tex TM , WL Gore Associates, UK) bladder neck slings in achieving continence in these children, with seemingly good short-term results [6]; we now present the long-term results.…”

Management of neurogenic voiding dysfunction in the male patient

“…This procedure requires ureteral reimplantation and is more difficult to perform in noncompliant, thick-walled bladders. Another method described for treating neurogenic sphincteric incompetence in children is the Kropp procedure, in which an anterior detrusor flap is tubularized and implanted into the trigone through a submucosal tunnel [23]. The major problem with this procedure is difficult catheterization [24].…”