Surgical therapy and rehabilitation training for children with hyper-reflexic neuropathic urinary incontinence

Yingzhong FAN; Da ZHANG; Jiaxiang WANG; Bianyun WANG; Qian ZHANG

ABSTRACT

BACKGROUND:

Myelodysplasia induced by spina bifida is one of the common developmental malformations of the nervous system in children, and neurogenic urinary incontinence induced by it can affect the children' s quality of life.

OBJECTIVE:

To observe the effects of surgical therapy and rehabilitation training for children with hyper-reflexic neuropathic urinary incontinence.

DESIGN:

A controlled follow-up observation.

SETTING:

Department of Pediatric Surgery, First Hospital Affiliated to Zhengzhou University.

PARTICIPANTS:

A total of 81 children(54 males and 27 females), aged 4 to 14 years treated for hyper-reflexic neuropathic urinary incontinence between January 1992 and October 2000 were selected. All the cases were confirmed loose pelvic floor muscle and smaller bladder capaeity before operation. Moreover, all cases with neuropathic urinary incontinence were proved to be hyper-reflexic neurogenic bladder by urodynamic examination.

METHODS:

Pelvic muscles of the 81 patients were strengthened with bilateral iliopsoas and the bladder was augmented on the basis of ileocystoplasty. Five patients had an additional bladder neck suspension. Wound healing was satisfactory after 3 weeks; therefore, rehabilitative exercise for coordination was performed. The improvements in symptoms and urodynamic results were followed up.

RESULTS:

Urinary catheters were removed in the 81 patients 2 weeks after operation. Forty patients had voiding desire before micturition, with linear urine current, more than 60 minutes' interval between micturitions, and almost normal or normal maximal bladder capacity and pressure and residual urine volume, which was regarded as significantly improved. Twenty-three patients had voiding desire before micturition, with linear urine current, more than 40 minutes' interval between micturitions, and reduced maximal bladder capacity and residual urine volume, but increased bladder pressure, which was regarded as improved. However, 18 patients were improved after regular bladder training. The postoperative urodynamic results in 9 patients showed that the average bladder pressure, average urethra pressure, residual urine volume and maximal bladder capacity were 1.2 kPa, 1.15 kPa, 30 - 50 mL and 300 -600 mL, respectively. Of the 81 cases, 63 cases were followed up completely for 6 months whereas the others had no complete follow-up data. The follow-up results showed significant outcomes in 56 cases, improvement in 5 and no effect in 2, with the total effective rate of 97%.

CONCLUSION:

Satisfactory results can be obtained by combined augmentative ileocystoplasty with strengthening of pelvic floor by iliopsoas for children with hyer-reflexic neuropathic urinary incontinence. The combination of micturition reflex and control training after operation produces obvious therapeutic effects.