Neurogenic Bladder Incontinence Research Articles

Results of a defined surgical protocol for treating pediatric neurogenic bladder incontinence in a single institution

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. 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. 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. 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. 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.

A Retrospective Case Series of High-Frequency Spinal Cord Stimulation (HF10-SCS) in Neurogenic Bladder Incontinence.

Current treatment options for bladder disorders of neurogenic etiology often leave unsatisfactory results. Therefore, new and effective treatments must be investigated. High-frequency spinal cord stimulation (HF-SCS) at 10 kHz has proven to be effective in the treatment of refractory chronic back and leg pain. To evaluate the efficacy of HF-SCS at 10 kHz in alleviating lower urinary tract dysfunction and bladder incontinence in 5 patients with underlying neurological disease or spinal cord injury, through retrospective study. Urodynamic parameters such as voiding frequency, residual volume, episodes of incontinence, and the patients' subjective impression impairment of life were assessed and compared pre- and postoperatively. Reduction in pain intensity was assessed as change on the Numeric Rating Scale (NRS). All 5 patients had significantly positive outcomes. Episodes of leakage per day improved by 83% on average. Quality of life questionnaires and subjective bother scale revealed an improvement of 36% and 57%, respectively. Individual symptoms among the patient group such as residual volume also responded to the treatment as well. Mean pain NRS of 8.6 cm was reduced to 3.9 cm (55%) at 6 mo follow-up. HF-SCS at 10 kHz significantly alleviated symptoms of neurogenic bladder incontinence in patients suffering from neurological disease or spinal cord injury. However, larger and prospective, randomized studies are necessary to make a clear statement regarding the efficacy of this therapy in lower urinary tract dysfunction and bladder incontinence.

Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: No Augmentation

No AccessJournal of UrologyOpposing View1 May 2013Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: No Augmentation Warren T. Snodgrass Warren T. SnodgrassWarren T. Snodgrass More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.068AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Augmentation vs No Augmentation for Neurogenic Bladder Incontinence: No Augmentation." The Journal of Urology, 189(5), pp. 1628–1629 References 1 : Artificial urinary sphincter in the treatment of urinary incontinence: preoperative urodynamics do not predict the need for future bladder augmentation. J Urol1998; 160: 1093. Link, Google Scholar 2 : Is long-term bladder deterioration inevitable following successful isolated bladder outlet procedures in children with neuropathic bladder dysfunction?. J Urol2008; 179: 1991. Link, Google Scholar 3 : Use of the fascial sling for neurogenic incontinence: lessons learned. J Urol1993; 150: 683. Link, Google Scholar 4 : Biological response of bladders rendered continent by insertion of artificial sphincter. J Urol1987; 138: 1116. Link, Google Scholar 5 : A single-centre long-term outcome analysis of artificial urinary sphincter placement in children. BJU Int2002; 89: 82. Google Scholar Department of Urology, UT Southwestern Medical Center, Dallas, Texas© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 5May 2013Page: 1628-1629 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Warren T. Snodgrass More articles by this author Expand All Advertisement PDF downloadLoading ...

The Pippi Salle procedure for neurogenic urinary incontinence in childhood: a three-year experience.

A three-year retrospective study was performed to assess the place of the Pippi Salle bladder neck repair in the treatment of neurogenic bladder incontinence in both sexes in childhood. All children who underwent the procedure between November 1995 and November 1998 were studied retrospectively. There were 18 children: 12 with spina bifida, 5 with sacral agenesis and 1 with an idiopathic neurogenic bladder. There were 11 boys and 7 girls. Their age was 3-14 years (median 7 years) and the length of follow-up was 7 months to 3 years (median 2 years). A midline bladder wall flap was fashioned in all patients. The procedure was performed alone (n = 5) or in combination with a sigmoid colocystoplasty (n = 9) or a Mitrofanoff catheterisable stoma (n = 2) or both (n = 2). Diurnal continence (3 hours or more) was achieved in 11 of the 18 children (61%); 2 are dry for 2-2.5 hours and 5 are incontinent. Eight of the 18 children (44%) are completely dry during the night, 2 are damp and 8 are incontinent. Twelve children (67%) needed oxybutynin to maintain a good result. Complications arose in 5 children (28%): difficulty with catheterisation (n = 4) and pelvic abscess (n = 1). Seven children (39%) subsequently required further operations: exploration of bladder for urine leak (n = 2), reinsertion of dislodged catheter (n = 1), drainage of pelvic abscess (n = 1), bladder neck injection with macroplastique (n = 1) and bladder neck closure (n = 2). The Pippi Salle bladder neck repair has an undoubted place in the management of neurogenic urinary incontinence in childhood. However, in our experience, it has a relatively high complication rate and failure rate.