Pediatric urinary incontinence: evaluation of bladder wall wraparound sling procedure.

PURPOSE: In 1996 a surgical procedure for sphincter deficiency was reported in patients with neurogenic urinary incontinence. To our knowledge we report the first series that assesses this procedure since it was initially described. MATERIALS AND METHODS: Seven female and 7 male patients with spinal dysraphism and neurogenic intrinsic sphincter deficiency underwent surgery between 1997 and 2005. All patients had an associated poorly compliant or small capacity bladder. Patient age ranged from 8 to 22 years (mean 14) and all patients presented with persistent urinary incontinence despite intermittent catheterization and pharmacotherapy. Evaluation was based on clinical examination, as well as preoperative and postoperative urodynamic assessments. The surgical procedure involved wrapping a pedicle strip of anterior bladder wall around the bladder neck and fixing it on the pubic symphysis. Bladder augmentation cystoplasty was also routinely performed during the same procedure. RESULTS: Of 14 patients 13 were completely dry and 1 had stress incontinence. Followup was 2 to 8 years (mean 5). Postoperative urodynamic evaluation showed a maximum urethral pressure increase of 40%. We also observed an increase in bladder capacity of 105% and improved bladder compliance (7 ml/cm H(2)O preoperatively vs 35 ml/cm H(2)O postoperatively). CONCLUSIONS: The bladder wall wraparound sling procedure provides excellent results for continence in association with bladder augmentation.

[Uroflowmetric functional evaluation of modified Duplay procedure in hypospadias surgery]. / Evaluation fonctionnelle par débitmétrie de l'urétroplastie de Duplay modifiée dans la chirurgie de l'hypospade.

We perform a modified Duplay procedure in our department without incision of the urethral plate for correction of distal hypospadias. The objective of this retrospective study was to analyse the long-term functional and aesthetic results of this technique. Strictures are a frequent complication of hypospadias surgery, but their frequency is often underestimated as they can remain asymptomatic. We decided to systematically detect urethral strictures by performing voiding uroflowmetry in all children over the age of 4 years, i.e. toilet trained, operated by Duplay procedure in our department. The results were compared to the standard results in paediatric populations published in the literature. The maximum flow rate was below the 5th percentile in 20% of cases and the average flow rate was abnormal in 30% of cases. Voiding uroflowmetry is a simple, noninvasive method to detect asymptomatic urethral strictures. Uroflowmetry is essential to evaluate the functional results of surgical procedures used for the treatment of hypospadias.

Ureteropelvic junction obstruction in children: two variants of the same congenital anomaly?

OBJECTIVE: To compare the characteristics of prenatally and postnatally diagnosed ureteropelvic junction obstruction (UPJO) in children. PATIENTS AND METHODS: We reviewed the records of 74 children who underwent pyeloplasty or nephrectomy for UPJO between 1995 and 2000. The patients were divided into 2 groups: prenatally and postnatally diagnosed UPJO. In each group, we compared age at surgery, gender, affected side, anteroposterior diameter (APD) of the renal pelvis, surgical findings, and renal function as determined by creatinine clearance. RESULTS: Of the 74 children, 44 (59.4 percent) had a prenatal diagnosis of UPJO and 30 (40.6 percent) had a postnatal diagnosis despite the fact that all had had a fetal ultrasonography. Median age at the time of surgery was 6.3 years (4 months to 16 years) for children with postnatal UPJO and 3.6 months (1 month to 4 years) for the prenatal group. Forty-three percent of the children in the postnatal group and 25 percent in the prenatal group were females. Clinical manifestations in children with postnatal UPJO included abdominal pain in 13 (43 percent) patients, pyelonephritis in 7 (23 percent), urinary tract infection in 5 (16.6 percent), and occasional findings upon ultrasound in 5 (16.6 percent). Excretory urography suggested obstruction in most children. The surgical findings included ureteral kinks due to adhesions in 93.3 percent of postnatally diagnosed UPJO cases and in 27.3 percent of prenatal cases (p < 0.01). A reduction in mean creatinine clearance of hydronephrotic kidneys was observed for both groups when compared to reference values for the respective ages, but this difference was not statistically significant. CONCLUSIONS: Postnatally diagnosed UPJO may be considered, at least in part, an entity different from prenatally detected obstruction due to its peculiar characteristics, i.e., postnatal UPJO more frequently affects females, manifests later in life with urinary infection or abdominal pain, and is frequently associated with ureteral kinking.

Ureteropelvic junction obstruction in children: two variants of the same congenital anomaly?

OBJECTIVE: To compare the characteristics of prenatally and postnatally diagnosed ureteropelvic junction obstruction (UPJO) in children. PATIENTS AND METHODS: We reviewed the records of 74 children who underwent pyeloplasty or nephrectomy for UPJO between 1995 and 2000. The patients were divided into 2 groups: prenatally and postnatally diagnosed UPJO. In each group, we compared age at surgery, gender, affected side, anteroposterior diameter (APD) of the renal pelvis, surgical findings, and renal function as determined by creatinine clearance. RESULTS: Of the 74 children, 44 (59.4%) had a prenatal diagnosis of UPJO and 30 (40.6%) had a postnatal diagnosis despite the fact that all had had a fetal ultrasonography. Median age at the time of surgery was 6.3 years (4 months to 16 years) for children with postnatal UPJO and 3.6 months (1 month to 4 years) for the prenatal group. Forty-three percent of the children in the postnatal group and 25% in the prenatal group were females. Clinical manifestations in children with postnatal UPJO included abdominal pain in 13 (43%) patients, pyelonephritis in 7 (23%), urinary tract infection in 5 (16.6%), and occasional findings upon ultrasound in 5 (16.6%). Excretory urography suggested obstruction in most children. The surgical findings included ureteral kinks due to adhesions in 93.3% of postnatally diagnosed UPJO cases and in 27.3% of prenatal cases (p < 0.01). A reduction in mean creatinine clearance of hydronephrotic kidneys was observed for both groups when compared to reference values for the respective ages, but this difference was not statistically significant. CONCLUSIONS: Postnatally diagnosed UPJO may be considered, at least in part, an entity different from prenatally detected obstruction due to its peculiar characteristics, i.e., postnatal UPJO more frequently affects females, manifests later in life with urinary infection or abdominal pain, and is frequently associated with ureteral kinking.

[Survey on satisfaction of patients with Malone continent cecostomy]. / Enquête sur la satisfaction des patients porteurs d'une caecostomie continente de Malone.

OBJECTIVE: A questionnaire to assess their level of satisfaction was sent to 28 patients who underwent a continent cecostomy for antegrade enema (Malone procedure). MATERIAL AND METHOD: All the patients presented with neurogenic bladder and a severe constipation due to spina bifida in 21 cases, anorectal malformation in 4, cloacal malformation in 1, sacral agenesis in 1 and post-myelitis paraplegia in 1. The mean age at surgery was 15 years. The mean follow-up is 3 years and 8 months. Surgery on the bladder was done in 18 patients of which 10 at the same stage. Urinary continence between bladder catheterizations occurred in 5 patients with isolated cecostomy. RESULTS: 24 patients answered the questionnaire. Among the remaining 4, 1 has a too short follow-up, 1 refused the enemas and his cecostomy definitely closed and 2, when seen at clinics, have an excellent result. Enemas are done twice a week, they last on average one hour with an average of 3 litres of liquid, usually tap water. All the 24 patients consider to have benefited from the operation mainly regarding their personal, family and social wellbeing. All have acquired anal continence, only 3 have some soiling between enemas. The main reported drawbacks concern pain at passing of stools (14 cases) well improved by addition of Colopeg in the enema, fatigue (21 cases) or headache (5 cases) after enemas. These troubles, probably due to a temporary hyponatremia, are well improved by addition of table salt in the water. CONCLUSION: This enquiry established the high degree of satisfaction given by the Malone procedure in the treatment of severe constipation frequently associated with a congenital neurogenic bladder. Despite some drawbacks this solution must be considered in such situation.