Sling suspension of the bladder neck for pediatric urinary incontinence

Abstract 

Objective

Surgery for urinary incontinence in childhood is in the process of an ongoing search for better results because a procedure that guarantees dryness still does not exist. This study has been conducted to assess the overall results of the fascia sling procedure for incontinence in children.

Material and methods

Eighty-nine patients with neurogenic lower urinary tract dysfunction and follow-up of more than 2 years have been included in the study (46 boys and 43 girls aged 2–17 years). All patients underwent U-type sling suspension of the bladder neck. In 59 patients detrusorectomy and in 11 patients bladder augmentation was performed. Sphincter incompetence was defined as low-pressure (<30cm H₂O) leakage observed during urodynamic studies. The results of surgery were assessed clinically (dryness intervals).

Results

Forty-two (47%) patients were completely dry, and 23 (26%) considerably improved. The success rate was higher in males (35) than in females (30) (76% vs 70%). Detrusorectomy did not improve the success rate of the sling procedure (68% vs 79% sling only), but bladder augmentation did (90%). Higher success rates have been observed in adolescents compared to prepubertal children (83% vs 56%). No serious complications were observed.

Conclusions

Rectus fascia sling suspension is a safe procedure and could be considered a good option for the treatment of neurogenic sphincter incompetence in children.

Keywords: Children, Rectus fascia sling, Sphincter incompetence