THE TREATMENT OF POST-URETHROTOMY INCONTINENCE IN PEDIATRIC AND ADOLESCENT FEMALES

Abstract

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Mar 2001THE TREATMENT OF POST-URETHROTOMY INCONTINENCE IN PEDIATRIC AND ADOLESCENT FEMALES TOM P. V.M. de JONG, JAN D. VAN GOOL, PIETER DIK, AART J. KLIJN, and MARIANNE A.W. VIJVERBERG TOM P. V.M. de JONGTOM P. V.M. de JONG More articles by this author , JAN D. VAN GOOLJAN D. VAN GOOL More articles by this author , PIETER DIKPIETER DIK More articles by this author , AART J. KLIJNAART J. KLIJN More articles by this author , and MARIANNE A.W. VIJVERBERGMARIANNE A.W. VIJVERBERG More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66577-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. Materials and Methods: Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have presented at our department with combined dysfunctional voiding, recurrent urinary tract infection and various types of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video urodynamics and ultrasound of the open bladder neck. Endoscopy provided proof of scarring in the bladder neck and urethra. All patients except 1 underwent conservative treatment for at least 2 years, consisting of pharmacological therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burch-type colposuspension in 5, modified needle colposuspension in 4 and complete endoscopic excision of the urethral scars followed by open reconstruction of the bladder neck and urethra in an abdominoperineal procedure in 5. Results: Conservative treatment has been completely successful in 7 patients. Primary open or needle colposuspension was unsuccessful in 6 of 9 cases, including several requiring further surgery to achieve dryness. The results of excising urethral scars with bladder neck and urethral reconstruction were good in 4 of 5 patients at a followup of at least 4 years. Conclusions: When previous internal urethrotomy appears to be an important factor in the evaluation of incontinence, conservative therapy is the treatment of choice. Conservative therapy should consist of biofeedback reeducation of the voiding pattern and physical therapy. When surgery is needed, excision of the urethral scars with reconstruction of the bladder neck and urethra plus colposuspension is superior to colposuspension only. References 1 : Internal urethrotomy and recurrent urinary tract infection in female children. I. Results in the management of infection. J Urol1968; 100: 297. Link, Google Scholar 2 : Bladder neck obstruction in children. J Urol1963; 89: 384. Link, Google Scholar 3 : A blind comparison of dilatation, urethrotomy and medication alone in the treatment of urinary tract infection in girls. J Urol1973; 109: 917. Link, Google Scholar 4 : Internal urethrotomy in girls and its impact on the urethral intrinsic and extrinsic continence mechanisms. J Urol1986; 136: 1248. Link, Google Scholar 5 : Internal urethrotomy in female subjects. J Urol1986; 136: 1280. Link, Google Scholar 6 : Bladder neck reconstruction for total urinary incontinence: 10 years experience. J Urol1981; 125: 321. Link, Google Scholar 7 : Construction of female urethra from vaginal wall and a perineal flap. J Urol1980; 123: 657. Google Scholar 8 : Bladder rehabilitation: the effect of a cognitive training program on urge incontinence. Eur Urol1997; 31: 68. Google Scholar 9 : Outpatient pelvic floor therapy in girls with daytime incontinence and dysfunctional voiding. Urology1996; 48: 923. Google Scholar 10 : Standardisation and definitions in lower urinary tract dysfunction in children. Br J Urol1998; 81: 1. Google Scholar From the Pediatric Renal Center, University Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 165Issue 3March 2001Page: 929-933 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsurinary incontinenceurethracicatrixurinary tract infectionsiatrogenic diseaseMetricsAuthor Information TOM P. V.M. de JONG More articles by this author JAN D. VAN GOOL More articles by this author PIETER DIK More articles by this author AART J. KLIJN More articles by this author MARIANNE A.W. VIJVERBERG More articles by this author Expand All Advertisement PDF downloadLoading ...