Initial Results Of A New Vesicoscopic Technique For The Treatment Of Low-Pressure Incontinence In Children
PURPOSE Surgery for sphincter incontinence remains challenging. Regardless of the methods the final success rates not usually exceed 70-80%. Short term results of a new vesicoscopic technique for bladder neck reconstruction are presented. MATERIAL AND METHODS Between Nov 2007 and Sept 2008 eight children (mean age 11,7 years), four with non-neurogenic, four with neurogenic sphincter dysfunction were operated. All had failed earlier surgery. All had leak-point pressure below 30 cm H2O. Mean follow up period is 5.8 months. Technique: In supine position, 3 ports are inserted into the bladder under direct visual control. U-shaped incision is done of the mucosa around the bladder neck leaving a strip mucosa on the anterior bladder wall that is tubularised. One lateral mucosal flap is used to cover the tube. A transurethral catheter is left for 3 weeks. RESULTS Mean operation time was 161 min (110 – 198 min). There was one conversion to open procedure. Mean postoperative hospital stay was 2.7 days (2 – 4 days). Transurethral CIC has been resumed in 4 children without any complication. Four patients are dry, two are sporadically wet but satisfied with the result and two patients are wet. CONCLUSIONS Short time results of vescicoscopic U-Bladder neck plasty are encouraging but long follow-up of a large group is necessary to evaluate the efficacy of this technique. Major advantage is the fact that it is a relatively minor surgery with excellent cosmetic results and quick recovery.