Surgical treatment of urinary incontinence in children

Česká verzia

Authors: Josef Sedláček
Authors place of work: Urologická klinika Všeobecné fakultní nemocnice v Praze a 1. LF UK v Praze
Published in the journal: Ces Urol 2019; 23(2): 101-113
Category: Review article

Summary

Major statement: Overview of contemporary options of surgical treatment of urinary incontinence in children and adolescents. Surgery for urinary incontinence are provided in children and adolescents with congenital and acquired disorders of lower urinary tract if pharmacological treatment and intermittent catheterization are ineffective. Furthermore, in children where only surgical treatment is possible. The aim of the treatment is a low pressure reservoir with good capacity and kidney protection. Methods respect the type of disorder, prospective development and risks. For bladder augmentation besides auto-augmentation and ureteral augmentation parts of the ileum and colon are used. In a patient with short-gut syndrome, cloacal extrophy or advanced renal insufficiency, gastric segments are used. Urine reabsorption by intestinal mucosa is the main cause of hyperchloremic acidosis. Mucus production, infection and residual urine are the main reasons of bladder stone development. Most serious long-time complication of bladder augmentation is tumor occurrence. If there is a disorder of continence mechanism, the treatment depends on anatomy, previous surgery and whether spontaneous voiding or intermittent catheterization are planned. The most effective method for spontaneous voiding is artificial sphincter implantation. Bladder neck reconstruction allowing possible spontaneous voiding is the Young-Dees-Leadbetter procedure. Nearly 80% of patients are continent after this operation. Bladder neck reconstruction with valvular closing mechanism necessitates intermittent catheterization in all cases. Sling procedures with bladder neck elevation result in continence rates between 50 – 80%. Endoscopic application of bulking agents in children is not recommended as a single procedure. Only as second line therapy for adjustment of other procedures.

Conclusion: Surgical treatment of urinary incontinence in children and adolescents is connected with important long‑life morbidity and risks. Regular choice of treatment method, life‑long follow‑up and good patient cooperation are necessary for optimal results.

Keywords:

urinary incontinence – neurogenic bladder – bladder extrophy – bladder augmentation – bladder-neck reconstruction – artificial sphincter.

Zdroje

1. Adams MC, Mitchell ME, Rink RC. Gastrocystoplasty: an alternative solution to the problém of urological reconstruction in the severely compromised patients. J Urol 1988; 140: 1152–1156.

2. Casey JT, Chan KH, Hasegawa Y, et al. Long‑term follow‑up of composite bladder augmentation incorporating stomach in a multi‑institutional cohort of patients with cloacal extrophy. J Pediatr Urol 2017; 13: 43.e1–43.e6.

3. Leonard MP, Dharamsi N, Williot PE. Outcome of dastrocystoplasty in tertiary pediatric urology practice. J Urol 2000; 164: 947–950.

4. Castellan M, Gosalbez R, Bar‑Yosef Y, Labbie A. Complication after use of gastric segments for lower urinary tract reconstruction. J Urol 2012; 187: 1823–1827.

5. Gosalbez R Jr, Kim CO. Ureterocystoplasty with preservation of ipsilateral renal function. J Ped surg 1996; 31: 970–975.

6. Ben‑Chaim J, Partin AW, Jeffs RD. Ureteral bladder augmentation using the lower pole ureter of a duplicated systém. Urology 1996; 47: 135–137.

7. Johal NS, Hamid R, Aslam Z, et al. Ureterocystoplasty: long‑term functional results. J Urol 2008; 179(6): 433–437.

8. Chrzan R, Dik P, Klijn AJ, Kuijper CF, deJong TPVM. Detrusorectomy reduce the need for augmentation and use od antimuscarinics in children with neuropathic bladders. J Pediatr Urol 2013; 9: 193–198.

9. Jednak R, Schimke CM, Barroso U Jr, Barthold JS Gonzales R. Further experience with seromuscular colocystoplasty lined with urothelium. J Urol 2000; 164: 2045–2049.

10. Gonzales R, Jednak R, Franc‑Guimond J, Schimke CM. Treating neuropathic incontinence in children with seromuscular colocystoplasty and artificial urinary sphincter. BJU Int 2002; 90: 909–911.

11. Fisch M, Hohenfellner M. Sigma‑rectum pouch (Mainz‑pouch II), BJU Int 2007; 99(4): 945–960.

12. Husmann DA, Spence HM. Current status of tumor of the bowel following ureterosigmoideostomy: a review. J Urol 1990; 144(3): 607–610.

13. Hadzi‑Djokovic JB, Basic DT. A modified sigma‑rectum pouch (Mainz pouch II) technique: analysis of outcomes and complications on 220 patients. BJU Int 2006; 97(3): 587–591.

14. Baky Fahmy MA, Al Shenawy AA, Shehata AA. Efficacy and safety of continent anal urinary diversion for complicated bladder extrophy in childrfen using mofified Duhemel’s procedure. J Pediatr Urol 2015; 11: 254e1–254e6.

15. Young HH. An operation for incontinence associated with epispadias. J Urol 1922; 7: 1–32.

16. Dees J. Congenital epispadias with incontinence. J Urol 1949; 62: 513–522.

17. Leadbetter GW. Surgical correction of total urinary incontinence. J Urol 1964; 91: 261–266.

18. Surer I, Baker LA, Jeffs RD, Gearhart JP. Modified Young‑Deese‑Leadbetter bladder neck reconstruction in patients with successful primary bladder closure elsewhere: a single institution experience. J Urol 2001; 165: 2438–2440.

19. Kropp KA, Angwafo FF. Urethral lengthening and reimplantation for neurogenic incontinence in children. J Urol 1986; 135: 533–536.

20. Salle JL. Urethral lengthening with anterior bladder wall flap (pippi Salle procedure): modifications and extended indications of the technique. J Urol 1997; 158: 586–590.

21. Grimsby GM, Menon V, Schlomer BJ, et al. Long‑term outcomes of bladder neck reconstruction without augmentation cystoplasty in children. J Urol 2016; 195(1): 155–161.

22. Snodgrass W, Villanueva C, Gargollo, et al. New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder. J Pediatr Urol 2014; 10: 906–910.

23. Whittam B, Szymanski K, Misseri RB, et al. Long‑term fate of the bladder after isolated bladder neck procedure. J Pediatr Urol 2014; 10(5): 886–891.

24. Nguyen HT, Baskin LS. The outcome of bladder neck closure in children with severe urinary incontinece. J Urol 2003; 169: 1114–1116.

25. Nijman R, Austin P, Bael A, et al. Diagnosis and management of urinary incontinence in childhood. In: Abrams P, Cardozo L, Wagg A, Wein A. Incontinence. 6th Edition.; Tokyo, ICS and ICUD, 2017; Vol 1: 1016–1031.

26. Lopez Pereira P, Samoza AI, MartAnez Urrutia MJ, Lobato RR, Jaureguizar ME. Artificial urinary sphincter: 11-year experience in adolescents with congental neuropathic baldder. Eur Urol 2006; 50(5): 1096–1101.

27. Rodo JS, Cáceres FA, Lerena JR, Rossy E. Bladder augmentation and artificial urinary sphincter implantation: urodynamic behavior and effects on continence. J Pediatr Urol 2008; 4(1): 8–13.

28. Herndon CD, Rink RC, Shaw MB, et al. The Indiana experience with artificial urinary sphincters in children and young adults. J Urol 2003; 169: 650–654.

29. Singh G, Thomas DG. Artificial urinary sphincter in patients with neurogenic bladder dysfunction. Br J Urol 1996; 77: 252–255.

30. Godbole P, Mackinnon AE. Expanded PTFE bladder neck slings for incontinence in children: the long‑term outcome. BJU Int 2004; 93: 139–141.

31. Bugg CE Jr, Joseph DB. Bladder neck cinch for pediatric neurogenic outlet deficiency. J Urol 2003; 170: 1501–1503.

32. Misseri R, Cain MP, Casale AJ, et al. Small intestine submucosa baladder neck slings for incontinence associated with neuropathic bladder. J Urol 2005; 174 (4 Pt 2): 1680–1682.

33. Pérez LM, Smith EA, Broecker BH, et al. Outcome of sling cystourethropexy in the pediatric population: a critical review. J Urol 1996; 156(2 Pt 2): 642–646.

34. Pakkasjarvi N, Taskienen S. Does intraoperative success predict outcome in the treatment of urethral sphincter insufficiency with bulking agents? J Pediatr Urol 2018, https://doi.org/10.1016/j.jpurol.2017. 10. 020.

35. Lottmann HB, Margaryan M, Lortat‑Jacob S, Bernuy M, Lackgren G. Long‑term effects of dextranomer endoscopic injection for the treatment of urinary incontinence: an update of prospective study of 61 patients. J Urol 2006; 176(4 Pt 2): 1762–1766.

36. Woodhouse CRJ. The Mitrofanoff principle for continent urinary diversion. Word J Urology 1996; 14: 99–104.

37. Leng WW, Balock HJ, Fredricksson WH, English SF, McGuire EG. Enterocystoplasty or detrusor myomectomy: comparision of indications and outcomes for bladder augmentation. J Urol 1999; 161: 758–763.

38. Metcalfe PD, Cain MP, Keafer M, et al. What is the need for additional bladder surgery after baldder augmentation in children? J Urol 2006; 176(4 Pt 2): 1801–1805.

39. Husmann DA. Long‑term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration. Transl Androl Urol 2016; 5(1): 3–11.

40. Wagstaff KE, Wooodhouse CRJ, Rose GA, Duffy PG, Ransley PG. Blood and urine analysis in patients with intestinal bladders Br J Urol 1991; 68: 311–316.

41. Fontaine E, Leaver R, Woodhouse CRJ. The effect of intestinal urinary reservoir on renal function: a ten year follow‑up study. BJU Int 2000; 86: 195–198.

42. Riedmiller H, Gerharz EW, Kohl U, Weingartner K. Continent urinary diversion in preparation for renal transplantation: a staged approach. Transplantation 2000; 70: 1713–1717. 43. Palmer LS, Franco I, Kogan S, et al. Urolithiasis in children following augmentaation cystoplasty. J Urol 1993; 150: 726–729.

44. Mathoera RB, Kok DJ, Verduin CM Nijman RJM. Pathological and therapeutic significanceof cellular invasion by Proteus Mirabilis in an enterocystoplasty infection stone model. Infect Immun 2002; 70: 7022–7032.

45. Hensle TW, Bingham J, Lam J, Shabsigh A. Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol. BJU Int; 93: 585–587.

46. Husmann DA, Rathbun SR. Long‑term follow up of enteric bladder augmentations: risk for malignancy. Journal of Pediatric Urology 2008; 4: 381–385.

47. Biardeau X, Chartier‑Kastler E, Roupret M, Phé V. Risk of malignancy after augmentation cystoplasty: a systematic review. Neurourology and Urodynamics 2016; 35: 675–682.

48. Husmann DA. Mortality following augmentation cystoplasty: a transitional urologist’s viewpoint. Journal of Pediatric Urology 2017; 13: 358–364.

49. Catellan M, Gosalbez R, Perez‑Brayfield M, et al. Tumor in bladder reservoir after gastrocystoplasty. J Urol 2007; 178 (4 Pt 2): 1771–1774.

50. Vemulakonda VM, Lendvay TS, Shnorhavorian M, et al. Metastatic adenocarcinoma after augmentation gastrocystoplasty. J Urol 2008; 179(3): 1094–1096.