Ces Urol 2019, 23(2):101-113 | DOI: 10.48095/cccu2019007

Surgical treatment of urinary incontinence in children

Josef Sedláček

Urologická klinika Všeobecné fakultní nemocnice v Praze a 1. LF UK v Praze

Sedláček J. Surgical treatment of urinary incontinence in children. 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.

Received: November 18, 2018; Accepted: February 25, 2019; Prepublished online: March 14, 2019; Published: June 20, 2019