Document Detail

Comparison of bladder outlet procedures without augmentation in children with neurogenic incontinence.
MedLine Citation:
PMID:  20728128     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We compared continence results of the bladder neck sling vs the Leadbetter-Mitchell bladder neck procedure plus fascial sling in children with neurogenic urinary incontinence. MATERIALS AND METHODS: We compared consecutive patients who received a 360-degree tight bladder neck sling to subsequent, similar patients who underwent a Leadbetter-Mitchell bladder neck procedure plus fascial sling involving a 50% reduction in bladder neck and proximal urethral diameter before a 360-degree tight sling. All patients underwent simultaneous appendicovesicostomy and none had undergone prior or simultaneous augmentation. All patients followed similar preoperative and postoperative protocols for urodynamic evaluation and anticholinergic therapy with data maintained prospectively. RESULTS: After surgery 46% of 35 sling cases did not require pads vs 82% of 17 Leadbetter-Mitchell cases with a sling (p = 0.02). Mean followup was 28 months in sling and 13 months in Leadbetter-Mitchell cases. Initial urodynamics done approximately 6 months postoperatively were similar in the 2 cohorts and no patient had hydronephrosis. Transient low grade reflux occurred in 2 Leadbetter-Mitchell cases, of which 1 with increased intravesical pressures early after surgery that caused trabeculation received increased medical management. Augmentation was not done in any patient except 1 previously reported on after a sling. CONCLUSIONS: Patients undergoing Leadbetter-Mitchell procedure plus fascial sling were significantly less likely to require pads postoperatively than those with a sling alone. Adverse bladder changes have not required augmentation to date.
Warren Snodgrass; Theodore Barber
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-08-21
Journal Detail:
Title:  The Journal of urology     Volume:  184     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2010-11-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1775-80     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75207, USA.
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MeSH Terms
Child, Preschool
Prospective Studies
Suburethral Slings*
Urinary Bladder, Neurogenic / complications,  surgery*
Urinary Incontinence / etiology,  surgery*
Urologic Surgical Procedures / methods

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