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Dave S, Gandhi K, Clark J, Davidson J, Welk B, Wang PZT. Results of a defined surgical protocol for treating pediatric neurogenic bladder incontinence in a single institution. J Pediatr Urol 2024; 20 Suppl 1:S74-S80. [PMID: 38972821 DOI: 10.1016/j.jpurol.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Incontinent pediatric neurogenic bladder (NB) patients face social ostracization and potential renal deterioration. Reconstructive surgery, after maximal medical therapy, requires a difficult decision-making process. Current literature for NB surgeries is difficult to interpret given definitions of dryness, use of augmentation cystoplasty (AC) and the lack of renal preservation. This study assesses the results of a defined surgical protocol to treat incontinent NB patients, using a new composite outcome measure, which includes upper tracts status and a definition of dryness. MATERIALS AND METHODS This is a retrospective cohort study assessing 33 consecutive incontinent NB patients (Spina bifida 31, Sacral agenesis- 2) who underwent one of 2 procedures between 2008 and 2021. AC with a Mitrofanoff procedure (MP) was performed in patients who had a high detrusor leak point pressure (DLPP) and significant bladder trabeculations (N = 21, Group 1). Children with a low DLPP and non-trabeculated bladders, underwent a modified Young-Dees-Leadbetter/Mitchell procedure with a 360° autologous rectus fascial sling (BOP) with concomitant AC and MP (N-12, Group 2). Post-operative success was defined using a composite grading of success assessing dryness, upper tract stability and medication use. RESULTS The mean age at surgery was 11.6 years (SD = 6 years), with 21 in Group 1 and 12 in Group 2. Mean follow-up was 3.25 years, with a minimum 24-month follow-up period. Success rate was 90% in Group 1 and 66% in Group 2. No patient had upper tract deterioration following surgery. Redo-surgical intervention, was required in 38% of Group 1 and 50% of Group 2 patients. These include 3 bladder neck injections in Group 1 and 2 bladder neck closure in Group 2, with a final success rate to 95 % in Group 1 and 83 % in Group 2. DISCUSSION Achieving dryness and preserving upper tracts is a challenge in incontinent NB patients. Dryness rates achieved in this study is comparable, given complications and redo-surgery. Primary bladder neck closure is a radical intervention, but Group 2 patients, may benefit from an upfront discussion of the pros and cons of a bladder neck closure primarily or as a secondary procedure. CONCLUSIONS Isolated AC obtains acceptable results for a selected subset of incontinent NB patients with significant bladder trabeculation. For those requiring a BOP, the success rate is relatively lower with the higher rate of potential complications and need for redo-surgery.
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Affiliation(s)
- Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, ON, Canada.
| | - Karan Gandhi
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jordyn Clark
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jacob Davidson
- Department of Surgery, Division of Paediatric Surgery, Western University, London, ON, Canada
| | - Blayne Welk
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Peter Zhan Tao Wang
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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Koch VH, Lopes M, Furusawa E, Vaz K, Barroso U. Multidisciplinary management of people with spina bifida across the lifespan. Pediatr Nephrol 2024; 39:681-697. [PMID: 37501019 DOI: 10.1007/s00467-023-06067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
The average worldwide prevalence of neural tube defects (NTDs) is 1.0 per 1000 births. Its development is multifactorial due to genetic and non-genetic factors. Spina bifida (SB) is one of main representatives of NTD. The spinal cord lesion level is the main determinant of the level of paralysis, numbness, and difficulties with bladder/bowel functions. Myelomeningocele prenatal repair reduces hydrocephalus and hindbrain herniation and improves motor function. The severity of hydrocephalus is associated with poorer neurodevelopmental outcomes whether operated on prenatally or after birth. People with SB tend to have a lower IQ and cognitive difficulties. Early diagnosis, proactivity, and lifelong multidisciplinary follow-up are key protective issues. Invasive urological interventions should be considered in selected patients after failure of conservative treatment. Transition to adult care should be well planned as it is challenging. Health literacy is directly associated with success at transition. Sexuality and fertility should be addressed before/during puberty. Overall, the rates of fecal and urinary continence and skin breakdown increase with age, whereas the ability to ambulate declines with age. Bowel and urinary incontinence are independent predictors of lower health-related quality of life (HRQoL) in adults with SB. Bowel incontinence has negative impact on HRQoL regardless of frequency or amount. Long-term caregiver support should be offered at diagnosis. Survival at a mean of 50 years is poor, at 32%, due to central nervous system deaths, cancer, urological disease, and sepsis. Challenges to implementation of recommended practices exist, especially in low and middle-income countries.
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Affiliation(s)
- Vera H Koch
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil.
| | - MarcosTomasin Lopes
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Erika Furusawa
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Katharinne Vaz
- Division of Urology, Federal University of Bahia - UFBA, Salvador, BA, Brazil
| | - Ubirajara Barroso
- Division of Urology - Federal University of Bahia, Bahiana School of Medicine, Salvador, BA, Brazil
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Brönnimann E, Alova I, Vatta F, Blanc T, Lottmann H. What makes the bladder neck sling procedure a success in a selected population of children and adolescents? A STROBE-compliant investigation. J Pediatr Urol 2022; 18:187-195. [PMID: 35135726 DOI: 10.1016/j.jpurol.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Achievement of continence in children suffering from neurogenic bladder dysfunction or severe urogenital malformation is of fundamental importance to the wellbeing of affected children and their families. A valid approach to treating incontinence with hypoactive sphincter is the placement of a bladder neck sling thus increasing outlet resistance of the bladder. OBJECTIVES In this retrospective study in children and adolescents, we aimed to assess the outcome of bladder neck sling procedures conducted at our institution. In addition, we aimed to identify predictors of the successful correction of incontinence. PATIENTS AND METHODS We treated 36 patients (25 girls, 11 boys, aged 5.0-19.7 years). In total, 32 (88.9%) patients suffered from neurogenic incontinence. Overall, 16 patients had previously received unsuccessful injection of bulking agent into the bladder neck. For the bladder neck sling, we used a fascial strip of rectus abdominis muscle (n = 29), detrusor muscle (n = 6), or combined fascial and detrusor strip (n = 1). In 8 (22.2%) patients, the surgical procedure involved wrapping the strip around the bladder neck, while in 6 (16.7%) patients, the bladder neck was suspended with the sling. In 22 (61.1%) patients, the two techniques were combined. Overall, 22 (61.1%) and 9 (25.0%) patients additionally underwent enterocystoplasty or detrusorotomy, respectively. We assessed urinary continence of our patients after 3-6 months (first evaluation) and ≥12 months (final evaluation). We classified the state of continence as 'dry' (dry for >3 h between catheterizations and dry at night), 'significantly improved' (minimal incontinence, no more than one protective pad per day, interval of at least 3 h between catheterizations, dry at night, and no demand for additional treatment), or 'wet'. Bladder neck sling treatment was considered successful if the patient was rated as 'dry' or 'significantly improved'. RESULTS At the first evaluation, the bladder neck sling procedure proved successful in 19 (52.8%) patients. Enterocystoplasty significantly increased the success rate compared to detrusorotomy or no bladder augmentation (68.1% vs. 28.6%; p = 0.04). The remaining 17 patients who were still classified as wet after bladder neck sling placement subsequently underwent one or more additional interventions, i.e. implant injection (n = 11), bladder augmentation (n = 10), and/or sling replacement (n = 5). At the final evaluation after a median follow-up of 64.5 months (range, 12-181 months), continence without sling replacement was achieved in 29 (80.6%) of the 36 patients. CONCLUSION In our study population, bladder neck sling placement achieved good results in the treatment of severe organic urinary incontinence with hypoactive sphincter. To optimize treatment outcome, bladder neck sling placement should be combined with enterocystoplasty.
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Affiliation(s)
- Enrico Brönnimann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France; University Center of Pediatric Surgery of Western Switzerland, Division of Child and Adolescent Surgery, Department of Women, Child and Adolescent, Geneva University Hospitals, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
| | - Ilona Alova
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Henri Lottmann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
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Rehfuss A, Apfeld JC, Sebastião YV, McLeod DJ, Fuchs M, Dajusta D. Utilization of Augmentation Cystoplasty for Myelomeningocele Patients Remained Stable Over the Past Decade. Urology 2020; 142:195-199. [PMID: 32360629 DOI: 10.1016/j.urology.2020.04.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand the utilization of augmentation cystoplasty (AC) for the management of neurogenic bladder in children with myelomeningocele (MMC). AC carries considerable risk. To mitigate this, recent studies have emphasized alternatives to AC, but it is unknown if these interventions have resulted in fewer ACs being performed. Our goal was to evaluate the use of AC in MMC patients over the past decade. We hypothesized that the use of AC had decreased and that the age at AC increased. METHODS Using the Pediatric Health Information System, we studied patients with MMC who had an AC between January 2009 and December 2018. International Classification of Disease procedure codes were used to identify AC procedures. We quantified trends in AC utilization by estimating the annual proportion of MMC admissions with an AC. We also assessed trends in patient age at the time of AC. RESULTS Proportion of AC per MMC admissions across the study period was 4.8%. There was no significant annual trend in the overall number of ACs performed each quarter over the past decade nor was there any change in the estimated annual incidence rate ratio of AC (1.01, 95% confidence interval 0.96, 1.05; P =.75). The estimated annual change in patient age at procedure remained relatively constant over the study period (-0.03 years, 95% confidence interval -0.13, 0.07; P = .51). CONCLUSION Practice patterns for the utilization of AC in MMC did not change significantly over the past decade despite prominent voices in the literature emphasizing alternative interventions in this patient population.
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Affiliation(s)
| | - Jordan C Apfeld
- Center for Surgical Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Daryl J McLeod
- Division of Urology, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Molly Fuchs
- Division of Urology, Nationwide Children's Hospital, Columbus, OH
| | - Daniel Dajusta
- Division of Urology, Nationwide Children's Hospital, Columbus, OH
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Gargollo PC, White LA. Robotic-assisted bladder neck procedures in children with neurogenic bladder. World J Urol 2019; 38:1855-1864. [PMID: 31471741 DOI: 10.1007/s00345-019-02912-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To review the current status of robotic-assisted laparoscopic surgical techniques for bladder neck procedures in children with incontinence secondary to neurogenic bladder. METHODS A comprehensive review of the literature on robotic-assisted bladder neck procedures was conducted, with a focus on articles published in the last 25 years. These data were subsequently compared to published series of open bladder neck procedures and published results from robotic-assisted bladder neck reconstruction series completed at our institution. RESULTS The principle bladder neck procedures for incontinence in pediatric patients with neurogenic bladder include: Artificial Urinary Sphincter, Bladder Neck Sling, Bladder Neck Closure, and Bladder Neck Reconstruction. Continence rates range from 60 to 100% with a lack of expert consensus on the preferred procedure (or combination of procedures). Robotic-assisted approaches are associated with longer operative times, especially early in the surgical experience, but demonstrate equivalent continence rates with potential benefits including low interoperative blood loss, improved cosmesis, and decreased intra-abdominal adhesion formation. CONCLUSIONS Robotic-assisted procedures of the bladder neck are safe, feasible, follow the same steps and principles as those of open surgery and produce equivalent continence rates. Robotic-assisted techniques can be adapted to a variety of bladder neck procedures and safely expanded to selected patients with the previous open abdominal surgery.
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Affiliation(s)
- Patricio C Gargollo
- Division of Pediatric Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Lindsay A White
- Mayo Clinic and Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA.
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Noordhoff TC, van den Hoek J, Yska MJ, Wolffenbuttel KP, Blok BFM, Scheepe JR. Long-term follow-up of bladder outlet procedures in children with neurogenic urinary incontinence. J Pediatr Urol 2019; 15:35.e1-35.e8. [PMID: 30314731 DOI: 10.1016/j.jpurol.2018.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Achieving continence in children with neurogenic sphincteric incompetence is a challenge. Awareness of the long-term outcome in this young patient population is important. In the past 25 years, the study institution has built experience in bladder outlet procedures such as bladder neck sling and bladder neck reconstructions. OBJECTIVE The objective of this study was to evaluate the long-term outcome on continence and re-intervention rate of bladder outlet procedures in children with neurogenic urinary incontinence at the study institution. DESIGN All children who underwent a bladder neck procedure between 1992 and 2017 at the study institution were retrospectively reviewed. Continence at the end of follow-up was the primary endpoint, defined as 'dry' when there was an interval of a minimum of 4 h without urinary leakage. Non-parametric tests were used for statistical analysis. RESULTS During this 25-year period, a total of 60 children underwent a bladder outlet procedure, either a bladder neck sling (n = 43) or a bladder neck reconstruction (n = 17). The median age at surgery was 11.6 years (interquartile range [IQR] 7.8-13.9). Concomitant surgery consisted of bladder augmentation in 80% and continent catheterizable urinary channel in 97% of children. Dry rate within 1 year was 38%. After a median follow-up of 10.4 years (IQR 6.5-15.5), 77% of all children were dry. Twenty-five children (42%) needed one or more re-interventions, including redo of the bladder outlet procedure, other type of outlet procedure, bulking agents, bladder augmentation, and bladder neck closure. DISCUSSION This study confirms that achieving continence is a challenge. The inconsistent use of the definition of urinary continence creates confusion in the literature and makes comparison of outcome with other studies difficult. Openness of (long-term) results in achieving urinary continence is important and helpful for future patients. CONCLUSION On the long term, the majority of children with neurogenic urinary incontinence were dry after a bladder outlet procedure, but a considerable number of patients had a re-intervention. The initial outcome on continence was slightly disappointing. Reporting long-term results is essential and helpful for patient counseling.
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Affiliation(s)
- T C Noordhoff
- Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - J van den Hoek
- Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - M J Yska
- Department of Urology, Maasstad Hospital, Rotterdam, the Netherlands.
| | - K P Wolffenbuttel
- Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - B F M Blok
- Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - J R Scheepe
- Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Gargollo PC, White LA. Robotic-Assisted Bladder Neck Procedures for Incontinence in Pediatric Patients. Front Pediatr 2019; 7:172. [PMID: 31134167 PMCID: PMC6514215 DOI: 10.3389/fped.2019.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: To review the current status of bladder neck procedures for incontinence in pediatric patients, focusing on the increasing role of robotic-assisted laparoscopic surgical techniques. Methods: A comprehensive review of the literature on open and robotic-assisted bladder neck procedures was conducted, with a focus on articles published in the last 20 years. This data was subsequently compared with published results from robotic-assisted bladder neck reconstruction series completed at our institution. Results: The principal bladder neck procedures for incontinence in pediatric patients include: Artificial Urinary Sphincter, Bladder Neck Sling, Bladder Neck Closure and Bladder Neck Reconstruction. Continence rates range from 60 to 100% with a lack of expert consensus on the preferred procedure (or combination of procedures). Robotic-assisted approaches are associated with longer operative times, especially early in the surgical experience, but demonstrate equivalent continence rates with potential benefits including: low intraoperative blood loss, improved cosmesis, and decreased intra-abdominal adhesion formation. Conclusions: Robotic-assisted procedures of the bladder neck are safe, feasible, follow the same steps and principles as those of open surgery and produce equivalent continence rates. Robotic-assisted techniques can be adapted to a variety of bladder neck procedures and safely expanded to selected patients with previous open abdominal surgery.
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Affiliation(s)
- Patricio C Gargollo
- Division of Pediatric Urology, The Mayo Clinic and Mayo Medical School, Rochester, MN, United States
| | - Lindsay A White
- The University of Washington School of Medicine, Seattle, WA, United States
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Abstract
This article provides a comprehensive summary of the clinical approach, investigative modalities and management of a child with neurogenic bladder disease due to myelodysplasia. It is aimed at pediatric physicians and surgeons working in developing nations. The methodologies suggested are simple and can be practised even in resource poor regions. The goal of management is avoidance of Chronic kidney disease and for this, meticulous bladder management is the key.
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Myers JB, Mayer EN, Lenherr S. Management options for sphincteric deficiency in adults with neurogenic bladder. Transl Androl Urol 2016; 5:145-57. [PMID: 26904420 PMCID: PMC4739985 DOI: 10.3978/j.issn.2223-4683.2015.12.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neurogenic bladder is a very broad disease definition that encompasses varied disease and injury states affecting the bladder. The majority of patients with neurogenic bladder dysfunction do not have concomitant intrinsic sphincteric deficiency (ISD), but when this occurs the challenges of management of urinary incontinence from neurogenic bladder are compounded. There are no guidelines for surgical correction of ISD in adults and most of the literature on treatment of the problem comes from treatment of children with congenital diseases, such as myelomeningocele. Our goal, in this review, is to present some of the common surgical options for ISD [including artificial urinary sphincters, bladder slings, bladder neck reconstruction (BNR) and urethral bulking agents] and the evidence underlying these treatments in adults with neurogenic bladder.
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Affiliation(s)
- Jeremy B Myers
- The Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Erik N Mayer
- The Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Sara Lenherr
- The Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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Snodgrass W, Granberg C. Clinical indications for augmentation in children with neurogenic urinary incontinence following bladder outlet procedures: Results of a 14-year observational study. J Pediatr Urol 2016; 12:46.e1-8. [PMID: 26429598 DOI: 10.1016/j.jpurol.2015.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE We report continence, upper tract changes, and augmentation indications and rates in consecutive patients undergoing bladder outlet surgery without augmentation for neurogenic urinary incontinence. METHODS From 2000 to 2007, 37 patients underwent bladder neck sling (BNS), and from 2007 to 2013, 45 patients had Leadbetter/Mitchell bladder neck revision plus sling (LMS), all without augmentation. Mitrofanoff channels were created in all cases. Twenty children with persistent outlet insufficiency underwent bladder neck closure (BNC). All patients had pre- and postoperative urodynamic testing (UD). RESULTS Mean follow-up was 60 months after BNS, 38 months after LMS, and 29 months after BNC. Continence (dry, no pads) was achieved significantly more often with LMS versus BNS (66% vs. 37%). There were no significant differences between these patients in preoperative UD % capacity, end filling pressure (EFP), or compliance. Those that became dry had a greater % capacity on postoperative UD, but postoperative EFP was similar between dry and wet LMS and BNS patients. BNC resulted in dryness in 65% of patients, with most incontinence occurring from the Mitrofanoff stoma associated with filling pressures > 40 cm. A total of 10 (12%) children had augmentation, seven after BNC. Clinical indications were end filling pressures > 40 cm plus hydronephrosis ≥ grade 3, and/or persistent incontinence. Need for augmentation was not predicted by preoperative urodynamic parameters. Postoperative UD in those who were augmented showed significantly less % capacity and compliance, and significantly greater EFP, than those not augmented. CONCLUSIONS Dryness was achieved in only 33% of BNS versus 66% of LMS and BNC patients. Twelve percent of consecutive children undergoing bladder outlet surgery for neurogenic incontinence developed clinical parameters leading to augmentation. These occurred most often after BNC.
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Affiliation(s)
| | - Candace Granberg
- Division of Pediatric Urology, Department of Urology, Mayo Clinic, USA
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11
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Long-Term Outcomes of Bladder Neck Reconstruction without Augmentation Cystoplasty in Children. J Urol 2016; 195:155-61. [DOI: 10.1016/j.juro.2015.06.103] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2015] [Indexed: 11/22/2022]
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Grimsby GM, Jacobs MA, Menon V, Schlomer BJ, Gargollo PC. Perioperative and Short-Term Outcomes of Robotic vs Open Bladder Neck Procedures for Neurogenic Incontinence. J Urol 2015; 195:1088-92. [PMID: 26626215 DOI: 10.1016/j.juro.2015.11.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Complex urological reconstruction may be facilitated by the improved magnification and dexterity provided by a robotic approach. Minimally invasive surgery also has the potential advantages of decreased length of stay and improved convalescence. We reviewed perioperative and short-term outcomes between robot-assisted and open bladder neck sling/repair with catheterizable channel in patients with neurogenic bladder. MATERIALS AND METHODS We performed an institutional review board approved retrospective chart review of all patients who underwent open or robotic bladder neck reconstruction without augmentation cystoplasty for refractory urinary incontinence between 2010 and 2014. Age at surgery, operative time, length of stay, complications within 30 days of surgery and future continence procedures (injection of bladder neck/catheterizable channel, additional bladder neck surgery, botulinum toxin A injection) were compared between the groups. RESULTS A total of 45 patients underwent bladder neck reconstruction (open in 26, robotic in 19) with a mean follow up of 2.8 years. There was no difference in preoperative urodynamics, age at surgery or length of stay (median 4 days in each group, p >0.9). Operative time was significantly longer in the robotic group (8.2 vs 4.5 hours, p <0.001). Three patients (16%) undergoing robotic and 3 (12%) undergoing open surgery had a complication within 30 days (p >0.9). Of patients undergoing open repair 14 (56%) underwent 23 subsequent surgeries for incontinence. By comparison, 8 patients undergoing robotic repair (42%) underwent 12 additional procedures (p = 0.5). CONCLUSIONS Although a robotic approach may take longer to perform, it does not result in increased complications or length of stay, or worsened continence outcomes.
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Affiliation(s)
- Gwen M Grimsby
- Children's Health and University of Texas Southwestern Medical Center, Dallas and Texas Children's Hospital, Houston (PCG), Texas
| | - Micah A Jacobs
- Children's Health and University of Texas Southwestern Medical Center, Dallas and Texas Children's Hospital, Houston (PCG), Texas
| | - Vani Menon
- Children's Health and University of Texas Southwestern Medical Center, Dallas and Texas Children's Hospital, Houston (PCG), Texas
| | - Bruce J Schlomer
- Children's Health and University of Texas Southwestern Medical Center, Dallas and Texas Children's Hospital, Houston (PCG), Texas
| | - Patricio C Gargollo
- Children's Health and University of Texas Southwestern Medical Center, Dallas and Texas Children's Hospital, Houston (PCG), Texas.
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Schlomer BJ, Copp HL. Cumulative incidence of outcomes and urologic procedures after augmentation cystoplasty. J Pediatr Urol 2014; 10:1043-50. [PMID: 24766857 PMCID: PMC4195808 DOI: 10.1016/j.jpurol.2014.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Augmentation cystoplasty (AC) is a major surgery that can be associated with long-term morbidity. This study aimed to describe the cumulative incidence of outcomes and urologic procedures in a large cohort of children who underwent AC, identify significant sources of morbidity, and to evaluate baseline factors associated with outcomes of interest. METHODS Children≤18 years who underwent AC in the Pediatric Health Information System from 1999 to 2010 were included. All follow-up encounters up to June 2012 were included. Cumulative incidences for 15 outcomes and urologic procedures were calculated using non-informative censoring. Sensitivity analyses were performed to determine effect of censoring assumptions and including hospitals without complete datasets. As an exploratory analysis, baseline patient factors were evaluated for associations with outcomes and urologic procedures of interest using multivariable Cox proportional hazards models adjusted for clustering by hospital. RESULTS 2831 AC patients were identified. Based on cumulative incidence calculations and sensitivity analyses; the cumulative incidence ranges of outcomes and procedures at 1, 3, 5, and 10 years were calculated. Examples of 10-year cumulative incidence ranges are given for the following outcomes and procedures: bladder rupture (2.9-6.4%), small bowel obstruction (5.2-10.3%), bladder stones (13.3-36.0%), pyelonephritis (16.1-37.1%), cystolithopaxy (13.3-35.1%), and reaugmentation (5.2-13.4%). The development of chronic kidney disease was strongly associated with a diagnosis of lower urinary tract obstruction (HR 13.7; 95% CI 9.4-19.9). Bladder neck surgery and stoma creation at time of AC were associated with an increased hazard of bladder rupture (HR 1.9; 95% CI 1.1-3.3) and bladder stones (HR 1.4; 95% CI 1.1-1.8) respectively. CONCLUSIONS Outcomes of interest and urologic procedures after AC are common. Results from this large cohort can be used to counsel patients and families about expectations after AC. Pyelonephritis, chronic kidney disease, further reconstructive surgery, and calculus disease appear to cause significant morbidity. Collaborative efforts are needed to further reduce morbidity in this patient population.
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Affiliation(s)
- Bruce J Schlomer
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin, MC CCC-620, Houston, TX 77030, USA.
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Snodgrass W, Villanueva C, Gargollo P, Jacobs M. New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder. J Pediatr Urol 2014; 10:906-10. [PMID: 24680474 DOI: 10.1016/j.jpurol.2014.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence. MATERIALS AND METHODS Consecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually. RESULTS There were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet). CONCLUSIONS Upper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation.
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Affiliation(s)
- W Snodgrass
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
| | - C Villanueva
- University of Nebraska Medical Center, 988102 Nebraska Medical Center, Omaha, NE 68196-8102, USA.
| | - P Gargollo
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
| | - M Jacobs
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
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16
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Commentary to 'Upper tract changes in patients with neurogenic bladder and sustained pressures >40 cm following bladder neck surgery without augmentation'. J Pediatr Urol 2014; 10:749-51; discussion 751-2. [PMID: 24559859 DOI: 10.1016/j.jpurol.2014.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 11/23/2022]
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17
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Figueroa V, Romao R, Pippi Salle JL, Koyle MA, Braga LHP, Bägli DJ, Lorenzo AJ. Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children: effect of dose adjustment, multiple injections, and avoidance of reconstructive procedures. J Pediatr Urol 2014; 10:368-73. [PMID: 24280272 DOI: 10.1016/j.jpurol.2013.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/16/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Since 2007, intra-detrusor OnabotulinumtoxinA (OnabotA) injections have been selectively offered at our institution for cases in which maximal anticholinergic therapy failed or was not tolerated. Herein we present our experience with this approach. MATERIALS AND METHODS We prospectively obtained data on 17 patients who underwent OnabotA injections over a 4-year period. Demographic information, number of injections, and dose delivered were captured. Children were monitored with baseline and post-injection renal ultrasound, urodynamics, and assessed for side effects, satisfaction, and symptom improvement. RESULTS Forty-three sessions were performed with injections given every ∼ 6 months. Mean patient age was 10.7 years (range, 3-17). Compared with baseline, after the first injection, mean bladder capacity adjusted for age and compliance improved by 27% (p = 0.039) and 45.2% (p = 0.041), respectively. After subsequent injections, these values increased to 35.7% (p = 0.043) and 55.1% (p = 0.091), respectively. Out of 13 symptomatic patients, ≥ 50% improvement was reported in ten (76.9%) and complete resolution in seven (53.8%). However, all three patients in whom the maximum dose of OnabotA was reduced from 300 to 200 units complained of recurrent symptoms. Fourteen children avoided surgical reconstruction as a second line of treatment. Overall patient/parental reported satisfaction rate was 70.6% (12/17). CONCLUSIONS Intra-detrusor OnabotA injection is a promising intervention for management of neuropathic bladder in selected patients. Our data demonstrate improvement in symptoms and urodynamic parameters. Although an optimal dose has not been determined for children, we found optimal response with a maximum administration of OnabotA up to 300 units.
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Affiliation(s)
- V Figueroa
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - R Romao
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - J L Pippi Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - L H P Braga
- Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, ON, Canada
| | - D J Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - A J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Surgical management of pediatric urinary incontinence. Curr Urol Rep 2013; 14:342-9. [PMID: 23832825 DOI: 10.1007/s11934-013-0333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The surgical management of pediatric urinary incontinence secondary to neurogenic bladder and congenital anomalies is challenging, and continues to evolve with new surgical innovations. The goal of these surgical procedures is to achieve complete and socially acceptable urinary dryness, while preserving volitional voiding where possible, without causing damage to the upper tracts. This review focuses on recent studies and highlights the pros and cons of these advances, based on our experience. The short-term success in achieving urinary continence has to be tempered with the long-term implications of these reconstructive procedures, about which our knowledge is limited.
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DaJusta D, Gargollo P, Snodgrass W. Dextranomer/hyaluronic acid bladder neck injection for persistent outlet incompetency after sling procedures in children with neurogenic urinary incontinence. J Pediatr Urol 2013; 9:278-82. [PMID: 22560990 DOI: 10.1016/j.jpurol.2012.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We report outcomes after dextranomer/hyaluronic acid (Dx/HA) bladder neck injection for persistent outlet incompetency despite prior sling or Leadbetter/Mitchell bladder neck revision plus sling (LMS) in children with neurogenic urinary incontinence. METHODS Consecutive patients with outlet incompetency after sling (n = 17) or LMS (n = 9) underwent a maximum of 2 Dx/HA injections. Antegrade and/or retrograde endoscopy was used to access the bladder outlet, and injection done in quadrants to achieve visual mucosal coaptation. Outcomes were described as either "dry", not requiring pads, or "wet". RESULTS There were 24 children with follow-up after injection, of which 9 (38%) were initially dry and 15 (62%) remained wet. Of the 9 dry patients, 4 had recurrent incontinence at a mean of 16 months while 5 remained dry at a mean of 27 months. Second injections were done in a total of 14 children, with 1 dry at 39 months. Of all 24 children, up to 2 injections resulted in 6 (25%) dry patients, while the remainder was wet at last follow-up. Gender, initial outlet surgery, pre-injection pad use, injection technique, and volume injected did not predict outcomes. CONCLUSIONS Dx/HA bladder neck injection resulted in dryness in 25% of patients in this series after failed sling or LMS. Second injections after either initial failure or success achieved dryness in only 7%, and are no longer recommended.
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Affiliation(s)
- Daniel DaJusta
- Pediatric Urology Section, The University of Texas Southwestern Medical Center and, Children's Medical Center, Dallas, TX, USA
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20
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Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: Augmentation. J Urol 2013; 189:1629-30. [DOI: 10.1016/j.juro.2013.02.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/18/2022]
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Chrzan R, Dik P, Klijn AJ, Kuijper CF, de Jong TPVM. Detrusorectomy reduces the need for augmentation and use of antimuscarinics in children with neuropathic bladders. J Pediatr Urol 2013; 9:193-8. [PMID: 22364713 DOI: 10.1016/j.jpurol.2012.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 02/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess bladder behaviour and long-term outcome after detrusorectomy in children. MATERIAL AND METHODS Between 1990 and 2001, 49 detrusorectomies were performed (mean follow-up: 9.6 years) in children with neuropathic bladders (mean age at surgery: 9.8 years). Urodynamic study (UDS) was done before surgery (pre-UDS) and after surgery (UDS-1 and UDS-2). Bladder behaviour was assessed as good, fair or poor depending on the volume and intravesical pressure. In all patients, oxybutynin and clean intermittent catheterization were used preoperatively. In 24 patients, good bladder compliance and capacity were seen before detrusorectomy. RESULTS Good and fair outcomes were observed in 35 (71%) patients at 1 year and in 39 (79%) patients 6 years after detrusorectomy. In 30 (60%) patients, there was hardly any difference between the first and second follow-up. In 9 (18%) patients, formal bowel bladder augmentation was necessary: in 6 (12%) because of poor compliance and in 3 because of small bladder volume and incontinence. Seven patients improved during follow-up, 5 of them after resuming oxybutynin. In 11 patients, oxybutynin could be stopped, and in 2 the dosage could be reduced to once daily. CONCLUSIONS The good short-term results of detrusorectomy generally remain unchanged at long-term follow-up. Detrusorectomy can reduce the need for antimuscarinics, and the need for formal bladder augmentation in selected cases.
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Affiliation(s)
- Rafal Chrzan
- Paediatric Urology Centre WKZ Utrecht/EKZ Amsterdam, Department of Paediatric Urology, University Children's Hospital AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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22
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Bladder Neck Closure in Conjunction with Enterocystoplasty and Mitrofanoff Diversion for Complex Incontinence: Closing the Door for Good. J Urol 2012; 188:1561-5. [DOI: 10.1016/j.juro.2012.02.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 11/24/2022]
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23
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Drake MJ. The adult urology perspective on management of stress urinary incontinence in pediatric urology: ICI-RS 2011. Neurourol Urodyn 2012; 31:384-5. [PMID: 22415850 DOI: 10.1002/nau.22215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/12/2012] [Indexed: 11/08/2022]
Abstract
The modern era of patient-centered, multidisciplinary professional practice comes with the expectation of effective interaction between specialties dealing with closely related clinical areas. Interaction between adult and pediatric urology is generally limited in terms of training, conferences, and joint diagnostic/treatment algorithms. However, in the more complex cases managed by pediatric urologists, long-term medical input is commonly necessary. Accordingly, regular interaction between the relevant specialties would be beneficial for continuity of care of individual patients, achieving best results at transition to adolescence, awareness of long-term outcome of pediatric urological procedures and development of new surgical techniques. This article reviews the discussions at the 2011 International Consultation on Incontinence Research Society meeting in Bristol.
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Affiliation(s)
- Marcus J Drake
- Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK.
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Alova I, Margaryan M, Verkarre V, Bernuy M, Lortat Jacob S, Lottmann HB. Outcome of continence procedures after failed endoscopic treatment with dextranomer-based implants (DEFLUX®). J Pediatr Urol 2012; 8:40-6. [PMID: 21277831 DOI: 10.1016/j.jpurol.2010.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 12/02/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate outcome of further continence procedures after failure of endoscopic injections of dextranomer-based bulking agent. MATERIALS AND METHODS From 1997, 89 children (3-18 years) and one young adult were treated for incontinence with 145 endoscopic injections of dextranomer. On evaluation, each patient was classified as: dry, significantly improved, or treatment failure. Eighty-five patients had at least 12 months of follow up. Out of 34 (40%) treatment failures, 24 patients had a subsequent bladder neck procedure: artificial urinary sphincter (7), bladder neck plasty (9), bladder neck closure (1), fascial sling (3). Six patients had further endoscopic treatment (including 2 after bladder neck plasty). RESULTS At surgery, Deflux(®) paste was easily identified with minimal surrounding tissue inflammatory reaction. Artificial urinary sphincter: all 7 dry; bladder neck plasty: 7 dry, 1 improved and 1 still incontinent; 1 bladder neck closure patient dry; fascial sling: 1 significantly improved and 2 dry. Repeated endoscopic treatment: 1 dry, 1 improved and 4 failed. Eleven of the 21 (52%) patients who are either dry or improved have voiding abilities. CONCLUSION Endoscopic injections with dextranomer do not adversely affect the outcome of further surgical procedures. Repeated injections after a previous endoscopic treatment failure have a low success rate.
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Affiliation(s)
- I Alova
- Pediatric Surgery Department, (Pr Y. Révillon) Hop Necker Enfants-Malades, 149 Rue de Sèvres, 75015 Paris, France
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25
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Bagrodia A, Gargollo P. Robot-Assisted Bladder Neck Reconstruction, Bladder Neck Sling, and Appendicovesicostomy in Children: Description of Technique and Initial Results. J Endourol 2011; 25:1299-305. [DOI: 10.1089/end.2011.0031] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aditya Bagrodia
- Department of Urology, Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio Gargollo
- Department of Urology, Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas
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26
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Comparison of Bladder Outlet Procedures Without Augmentation in Children With Neurogenic Incontinence. J Urol 2010; 184:1775-80. [DOI: 10.1016/j.juro.2010.04.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Indexed: 11/18/2022]
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Abstract
Initial care of newborns with spina bifida centers on preventing bladder and upper tract damage from detrusor leak point pressure of greater than 40 cm H(2)O. The authors recommend using urodynamic-based management to select patients with elevated pressures for anticholinergic therapy and intermittent catheterization (CIC), using diapers and observation with biannual renal sonography for the remainder. At the age of toilet training, children who have urodynamic evidence of uninhibited contractions or rising pressure during filling are started on anticholinergics and CIC, or have their dosage increased until pressures less than 40 cm H(2)O and areflexia are achieved. Sphincter incompetency is diagnosed in incontinent children with pressures less than 40 cm H(2)O and areflexia or stress incontinence. Augmentation is indicated in patients with hydronephrosis or reflux and end-filling pressures or DLPP less than 40 cm H(2)O despite medical management to the point of patient tolerance. A minority of patients, not yet well-defined, will also need augmentation after bladder outlet surgery for similar postoperative indications.
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Affiliation(s)
- Warren T Snodgrass
- Department of Urology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX 75207, USA.
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Snodgrass W, Barber T, Cost N. Detrusor Compliance Changes After Bladder Neck Sling Without Augmentation in Children With Neurogenic Urinary Incontinence. J Urol 2010; 183:2361-6. [DOI: 10.1016/j.juro.2010.02.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Warren Snodgrass
- Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Theodore Barber
- Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Nicholas Cost
- Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
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29
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Stress Urinary Incontinence in Women with Neurogenic Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0060-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Clayton DB, Brock JW. The urologist's role in the management of spina bifida: a continuum of care. Urology 2010; 76:32-8. [PMID: 20350747 DOI: 10.1016/j.urology.2009.12.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 12/02/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Abstract
Caring for the child with spina bifida necessitates lifelong care by a coordinated team of health care providers, and the urologist plays a vital role in this team. The most important management goal of the urologist is the early establishment and consistent maintenance of a lower pressure urinary reservoir. Ensuring social continence along with its attendant social independence provides some of the greatest management challenges. In those patients who fail medical therapy, surgeons, caregivers, and patients must understand the scope of lower urinary tract reconstruction, the need for strict compliance, and the possibility of future surgery. In this article, we review the recent advances in spina bifida management.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, TN 37232, USA.
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31
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Rubenwolf PC, Beissert A, Gerharz EW, Riedmiller H. 15 years of continent urinary diversion and enterocystoplasty in children and adolescents: the Würzburg experience. BJU Int 2010; 105:698-705. [DOI: 10.1111/j.1464-410x.2009.08908.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chrzan R, Klijn AJ, Dik P, de Jong TPVM. U2B-dry: preliminary results of a new vesicoscopic technique for bladder neck repair in children. J Laparoendosc Adv Surg Tech A 2009; 20:293-6. [PMID: 19943779 DOI: 10.1089/lap.2009.0185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The aim of this work was to present a new vesicoscopic technique for treatment of sphincter insufficiency and to evaluate the short-term results. MATERIALS AND METHODS Eight children (mean age, 11.7 years), 4 with non-neurologic and 4 with neurologic sphincter incontinence, were operated on. All had previously failed open surgery. In all, leak-point pressure was below 30 cm H(2)O. Mean follow-up was 5.2 months. In the supine position, three ports were inserted into the bladder under direct visual control. A U-shaped incision was made in the mucosa around the bladder neck, leaving a strip of mucosa on the anterior bladder wall that was tubularized. One lateral mucosal flap was used to cover the tube. A transurethral catheter was left in for 3 weeks. RESULTS One conversion to open procedure was necessary because of leakage. Mean operation time was 161 minutes (range, 150-194). Postoperative hospital stay was between 2 and 4 days (mean, 2.7). Transurethral clean intermittent catheterization has been resumed in 4 children without complications. Four patients are dry, 2 are sporadically wet but satisfied with the result, and 2 patients are wet. CONCLUSIONS Vesicoscopic U-bladder neck plasty is a promising procedure. A major advantage of the technique is the fact that it is a relatively minor surgery with excellent cosmetic outcome and quick recovery.
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Affiliation(s)
- Rafal Chrzan
- Department of Pediatric Urology, WKZ Utrecht/EKZ Amsterdam, Amsterdam, The Netherlands.
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Dean GE, Kunkle DA. Outpatient Perineal Sling in Adolescent Boys With Neurogenic Incontinence. J Urol 2009; 182:1792-6. [DOI: 10.1016/j.juro.2009.04.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Gregory E. Dean
- Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - David A. Kunkle
- Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
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Snodgrass W, Keefover-Hicks A, Prieto J, Bush N, Adams R. Comparing Outcomes of Slings With Versus Without Enterocystoplasty for Neurogenic Urinary Incontinence. J Urol 2009; 181:2709-14; discussion 2714-6. [DOI: 10.1016/j.juro.2009.02.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Indexed: 10/20/2022]
Affiliation(s)
- Warren Snodgrass
- Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas and Children's Medical Center, Dallas, Texas
| | - Amy Keefover-Hicks
- Spina Bifida Program, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Juan Prieto
- Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas and Children's Medical Center, Dallas, Texas
| | - Nicol Bush
- Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas and Children's Medical Center, Dallas, Texas
| | - Richard Adams
- Spina Bifida Program, Texas Scottish Rite Hospital for Children, Dallas, Texas
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35
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Chrzan R, Dik P, Klijn AJ, de Jong TPVM. Sling suspension of the bladder neck for pediatric urinary incontinence. J Pediatr Urol 2009; 5:82-6. [PMID: 18976960 DOI: 10.1016/j.jpurol.2008.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 09/02/2008] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Surgery for urinary incontinence in childhood is in the process of an ongoing search for better results because a procedure that guarantees dryness still does not exist. This study has been conducted to assess the overall results of the fascia sling procedure for incontinence in children. MATERIAL AND METHODS Eighty-nine patients with neurogenic lower urinary tract dysfunction and follow-up of more than 2 years have been included in the study (46 boys and 43 girls aged 2-17 years). All patients underwent U-type sling suspension of the bladder neck. In 59 patients detrusorectomy and in 11 patients bladder augmentation was performed. Sphincter incompetence was defined as low-pressure (<30 cm H(2)O) leakage observed during urodynamic studies. The results of surgery were assessed clinically (dryness intervals). RESULTS Forty-two (47%) patients were completely dry, and 23 (26%) considerably improved. The success rate was higher in males (35) than in females (30) (76% vs 70%). Detrusorectomy did not improve the success rate of the sling procedure (68% vs 79% sling only), but bladder augmentation did (90%). Higher success rates have been observed in adolescents compared to prepubertal children (83% vs 56%). No serious complications were observed. CONCLUSIONS Rectus fascia sling suspension is a safe procedure and could be considered a good option for the treatment of neurogenic sphincter incompetence in children.
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Affiliation(s)
- Rafal Chrzan
- Department of Pediatric Urology, University Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
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36
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Snodgrass WT. Re: Is long-term bladder deterioration inevitable following successful isolated bladder outlet procedures in children with neuropathic bladder dysfunction? S. Dave, J. L. Pippi Salle, A. J. Lorenzo, L. H. Braga, M. H. Peralta-Del Valle, D. Bagli and A. E. Khoury J Urol 2008; 179: 1991-1996. J Urol 2008; 181:412-3; author reply 413-4. [PMID: 19019393 DOI: 10.1016/j.juro.2008.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Indexed: 11/26/2022]
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38
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Dave S, Pippi Salle JL, Lorenzo AJ, Braga LH, Peralta-Del Valle MH, Bägli D, Khoury AE. Is Long-Term Bladder Deterioration Inevitable Following Successful Isolated Bladder Outlet Procedures in Children With Neuropathic Bladder Dysfunction? J Urol 2008; 179:1991-6; discussion 1996. [DOI: 10.1016/j.juro.2008.01.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Sumit Dave
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Joao L. Pippi Salle
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Armando J. Lorenzo
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Luis H.P. Braga
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Darius Bägli
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Antoine E. Khoury
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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