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Surgical management of urinary incontinence in children with anatomical bladder‐outlet anomalies
Author(s) -
SHIMADA KENJI,
MATSUMOTO FUMI,
TOHDA AKIRA,
HARADA YASUNORI,
NAITOH YASUYUKI
Publication year - 2002
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1046/j.1442-2042.2002.00517.x
Subject(s) - medicine , ectopic ureter , neck of urinary bladder , urinary incontinence , ureter , stoma (medicine) , surgery , urinary system , urinary continence , epispadias , urinary diversion , vesicoureteral reflux , etiology , urethra , urinary bladder , bladder cancer , anatomy , cystectomy , reflux , prostate , disease , cancer , prostatectomy
Background: Pediatric urinary incontinence secondary to anatomical anomalies of the bladder outlet is relatively rare, and there is no consensus on its surgical treatment. We reviewed the clinical courses and surgical management of children with this pathology. Methods: From 1991 to 2001, we performed bladder neck reconstruction on seven children (three boys and four girls). The mean age at the first intervention was 7 years (range 5–12 years). The underlying diagnosis was bladder exstrophy in two children, pseudoureterocele‐type ectopic ureter in three, bladder neck incompetence from unknown etiology in one boy with hypospadias, and bilateral single ectopic ureter associated with cloacal malformations in one child. Lower urinary tract was evaluated through various imagings, endoscopy, and urodynamic studies. Results: The methods used to reconstruct the bladder neck was the Young‐Dees‐Leadbetter procedure (performed on four children); the Kropp procedure (two children); and the Pippi‐Salle procedure (one child). Bladder augmentation with intestinal segment was performed on four children; Mitrofanoff continent stoma was created in all patients. Urethral catheterization could not be routinely used in all patients, because of pain, stricture, or complicated urethral anatomy. All patients achieved urinary continence. Conclusion: The treatment of pediatric urinary incontinence from anatomical anomalies is technically challenging. Depending on the underlying disorders and anatomy, one needs to decide which method of reconstruction to perform. It would be safer to employ simultaneous augmentation and to create catheterizable continent stoma.