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Surgery for Incontinence

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Pediatric Urology

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Abstract

Structural urinary incontinence is mainly due to a deficiency of the bladder outlet continence mechanisms. This group comprises bladder exstrophy–epispadias, neurogenic bladder, and others. Patients affected by urinary incontinence should be investigated thoroughly to assess the bladder capacity and contractility and the bladder outlet resistance. Frequently, incontinence is due to a mixture of bladder overactivity and sphincter deficiency. After increasing the bladder outlet resistance, often the detrusor changes its behavior. Medical therapy, including intermittent catheterization, anticholinergics, and botulinum-A toxin, should be tested before bladder outlet surgery is proposed, and it should be reserved only for nonresponders to maximal medical therapy.

Bladder outlet surgery can be divided into elongation of the bladder neck and posterior urethra, aiming at increasing the resistance of the bladder outlet, using the bladder walls to create a long and narrow tube; it is used mainly in the exstrophy-epispadias group. Suspension of the bladder neck is popular mainly in female neuropathic bladder.

External compression of the urethra includes fixed compression by means of wraps or compression slings, using either patient’s tissues or synthetic devices. Variable external compression of the bladder outlet is provided by artificial urinary sphincter that is particularly indicated for those children who can void voluntarily.

Most Patients undergoing bladder outlet surgery, especially if coupled with bladder augmentation, will be bound to intermittent catheterization for the rest of their life, and this issue needs to be explained in depth before surgery.

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Acknowledgments

The author wants to thank Prof. Paolo Belgioioso, Professor of Artistic Anatomy at Accademia Albertina di Belle Arti, and Turin and his students Elena Zanonato, Maria Boschero, and Laura Dosio for their invaluable help in preparing the original drawings for this chapter.

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Authors and Affiliations

  1. Division of Pediatric Urology, Regina Margherita Children’s Hospital, Citta’ Della Salute e Della Scienza Di Torino, Torino, 10100, Italy

    Emilio Merlini

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  1. Emilio Merlini
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Correspondence to Emilio Merlini .

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Editors and Affiliations

  1. Pediatric Surgery, S. Orsola-Malpighi University Hospital, Bologna, Bologna, Italy

    Mario Lima

  2. Pediatric Urology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy

    Gianantonio Manzoni

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Merlini, E. (2015). Surgery for Incontinence. In: Lima, M., Manzoni, G. (eds) Pediatric Urology. Springer, Milano. https://doi.org/10.1007/978-88-470-5693-0_16

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  • DOI: https://doi.org/10.1007/978-88-470-5693-0_16

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  • Print ISBN: 978-88-470-5692-3

  • Online ISBN: 978-88-470-5693-0

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