Effectiveness of urethral endosphincteroplasty in children with urinary incontinence, myelodysplasia, and epispadias

Abstract

BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug. AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer. MATERIALS AND METHODS: The study analyzed 38 patients (517 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a stable polyacrylamide mesh polymer with silver ions were performed. RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children. DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system. CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.