Augmentation colocystoplasty and incontinence surgery in patients with spina bifida – our ongoing experience

Abstract

Background Successful management of urinary incontinence is a cornerstone in endowing patients of neurogenic incontinence with a good quality of life. In recent times introduction of clean intermittent catheterization and anticholinergics at an early age is thought to avoid future incontinence surgery. Over the last few years, we have a growing experience in the management of urinary incontinence in spina bifida. In this paper we present, a cohort of 9 consecutive cases of colocystoplasty and/or bladder neck repair and Mitrofanoff and/ or MACE procedures. A thorough preoperative work up, proper selection of cases, protocol based intraoperative and postoperative management is required for obtaining good results. These aspects are discussed in this paper. Materials and methods We present 9 of our patients in the age group of 4yrs19yrs, out of which 5 were boys and 4 girls. Augmentation colocystoplasty was done for all of them,7 underwent Mitrofanoff,5 underwent MACE,4 patients had a wide bladder neck and DEFLUX was injected in 2 of these patients,1 underwent Young-Dees-Leadbetter repair and a bladder neck ventrisuspension was done for 1 patient. Preoperative preparation extending over six months to one year included careful evaluation of each patient, thorough investigations, CIC training, anticholinergic medication, parental counselling and meticulous documentation.