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

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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 (5–17 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%.

About the authors

Alexandr A. Demidov

Veltishchev Research Clinical Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Medical University

Author for correspondence.
Email: demidoval10@list.ru
ORCID iD: 0000-0002-0788-9354
SPIN-code: 5568-8660

Can. Sci. (Med.), senior research associate

Russian Federation, Moscow

Elena V. Mlynchik

Speransky Children’s Hospital

Email: mlynchik@yanex.ru
ORCID iD: 0000-0003-2606-1218
SPIN-code: 4260-9453

Can. Sci. (Med.); urologist-andrologist for children

Russian Federation, Moscow

References

  1. Netto JM, Bastos AN, Figueiredo AA, Pérez LM. Spinal dysraphism: a neurosurgical review for the urologist. Rev Urol. 2009;11(2):71–81.
  2. Avagliano L, Massa V, George TM, et al. Overview on neuraltubedefects: From development to physical characteristics. Birth Defects Res. 2019;111(19):1455–1467. doi: 10.1002/bdr2.1380
  3. Deora H, Srinivas D, Shukla D, et al. Multiple-site neural tube defects: embryogenesis with complete review of existing literature. Neurosurgery Focus. 2019;47(4):E18. doi: 10.3171/2019.8.FOCUS19437
  4. Amarante MA, Shrensel JA, Tomei KL, et al. Management of urological dysfunction in pediatric patients with spinal dysraphism: review of the literature. Neurosurgery Focus. 2012;33(4):E4. doi: 10.3171/2012.7.FOCUS12232
  5. Mohamed W. Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment. World J Nephrol. 2021;10(4):37–46. doi: 10.5527/wjn.v10.i4.37
  6. Vishnevsky EL, Loran OB, Demidov AA. Reconstruction of urethra by epispadia in girls. Russian Bulletin of Pediatric Surgery, Anesthesiology and Resuscitation. 2010;(1):74–78.
  7. Demidov AA, Mlynchik EV. Combined application of chemodenervation implants in children with myelodysplasia and incontinence. Pediatric Surgery. 2014;18(5):18–22
  8. Demidov AA. The use of synthetic slings in surgical treatment of epispadias in boys. Bulletin of the RSMU. 2016;(5):22–28.
  9. Bryan C. Murless M.B. The injection treatment of stress incontinence. An International Journal of Obstetrics and Gynecology. 1938;45(1):67–73. doi: 10.1111/j.1471-0528.1938.tb12430.x
  10. Krivoborodov GG, Shkolnikov ME. Lechenie funktsionalnykh narushenii oporozhneniya mochevogo puzyrya Lechaschi vrach. 2004. Available from: https://www.lvrach.ru/2004/09/4531686. (In Russ.)
  11. Barbara M, Ludwikowski L, Jan-Christoph B, et al. Surgical management of neurogenic sphincter incompetence in children. Frontiers in Pediatrics. 2019;7:97. doi: 10.3389/fped.2019.00097
  12. Langer S, Radtke C, Györi E, et al. Bladder augmentation in children: current problems and experimental strategies for reconstruction. Wien Med Wochenschr. 2019;169(3–4):61–70. doi: 10.1007/s10354-018-0645-z
  13. Costa P, Ferreira C, Bracchitta D, Bryckaert P-É. Laparoscopic appendicovesicostomy and ileovesicostomy: a step-by-step technique description in neurogenic patients. Urology Annals. 2019;11(4):399–404. doi: 10.4103/UA.UA_167_18
  14. Sager C, Barroso U Jr, Netto JM, et al. Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment. International Brazilian Journal of Urology. 2022;48(1):31–51. doi: 10.1590/S1677-5538.IBJU.2020.0989
  15. Derzhavin VM, Zvyagintsev AE, Vishnevskii EL. Diagnostika narushenii funktsional’nogo sostoyaniya nizhnikh mochevykh putei u detei metodom pryamoi tsistometrii. Urologiya i Nefrologiya. 1973;(4):27–31.
  16. Vishnevskij EL, Loran OB, Vishnevskij AE. Klinicheskaya otsenka rasstroistv mocheispuskaniya. Moscow: Terra; 2001. 93 p.
  17. Paweł K. Pharmacotherapy for Pediatric Neurogenic Bladder. Pediatr Drugs. 2017;19(5):463–478. doi: 10.1007/s40272-017-0249-x
  18. Moussa M, Papatsoris AG, Chakra MA, et al. Perspectives on urological care in spina bifida patients. Intractable and Rare Diseases Research. 2021;10(1):1–10. doi: 10.5582/irdr.2020.03077
  19. Petros PE, Ulmsten U.I. The combined intravaginal sling and tuck operation. An ambulatory procedure for cure of stress and urge incontinence. Acta Obstet Gynecol Scand Suppl. 1990;153:53–59. doi: 10.1111/j.1600-0412.1990.tb08032.x
  20. Ulmsten U.I. An introduction to tension-free vaginal tape (TVT) — a new surgical procedure for treatment of female urinary incontinence. Int Urogynecol J Floor Dysfunct. 2001;12(2):S3–S4. doi: 10.1007/pl00014599
  21. Ulmsten UI, Petros PЕ. Surgery for female urinary incontinence. Curr Opin Obstet Gynecol. 1992;4(3):456–462.
  22. Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. European Urology. 2004;45(2):203–208. doi: 10.1016/j.eururo.2003.12.001
  23. Dzhavad-Zade MD, Derzhavin VM, Vishnevskii EL. Neirogennye disfunktsii mochevogo puzyrya. Moscow: Meditsina; 1989. P. 186–190.
  24. Ronkin MA, Ivanov LB. Reografiya v klinicheskoi praktike. Moscow: Nauchno-meditsinskaya firma MBN; 1997. P. 250.
  25. Zenkov LR, Ronkin MA. Funktsionalnaya diagnostika nervnykh boleznei. Moscow: Meditsina; 1991. P. 526–612.
  26. Groat WC, Yoshimura N. Afferent nerve regulation of bladder function in health and disease. Handbook experimental pharmacology. 2009;(194):91–138. doi: 10.1007/978-3-540-79090-7_4
  27. Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Comprehensive Physiology. 2015;5(1):327–396. doi: 10.1002/cphy.c130056
  28. Da Justa D, Gargollo P, Snodgrass W. Dextranomer/hyaluronic acid bladder neck injection for persistent outlet incompetency after sling procedures in children with neurogenic urinary incontinence. Journal Pediatric Urology. 2013;9(3):278–282. doi: 10.1016/j.jpurol.2012.03.013
  29. Farag F, Koens M, Sievert K, et al. Surgical treatment of neurogenic stress urinary incontinence: A systematic review of quality assessment and surgical outcomes. Neurourology and Urodynamics. 2016;35(1):21–25. doi: 10.1002/nau.22682
  30. Reuvers S, Groen J, Scheepe J, et al. Heterogeneity in reporting on urinary outcome and cure after surgical interventions for stress urinary incontinence in adult neurourological patients: a systematic review. Neurourology and Urodynamics. 2018;37(2):554–565. doi: 10.1002/nau.23364
  31. Caione P, Capozza N. Endoscopic treatment of urinary incontinence in pediatric patients: 2-year experience with dextranomer/hyaluronic acid copolymer. Journal Urology. 2002;168(4):1868–1871. doi: 10.1097/00005392-200210020-00050
  32. Riachy E, Defoor W, Reddy P, et al. Endoscopic treatment with dextranomer/hyaluronic acid for persistent incontinence after continent urinary reconstruction. Journal Endourology. 2015;29(2):137–140. doi: 10.1089/end.2014.0326
  33. De Vocht T, Chrzan R, Dik P, et al. Long-term results of bulking agent injection for persistent incontinence in cases of neurogenic bladder dysfunction. Journal Urology. 2010;183(2):719–723. doi: 10.1016/j.juro.2009.10.044
  34. Alova I, Margaryan M, Bernuy M, et al. Long-term effects of endoscopic injection of dextranomer/hyaluronic acid based implants for treatment of urinary incontinence in children with neurogenic bladder. Journal Urology. 2012;188(5):1905–1909. doi: 10.1016/j.juro.2012.07.016
  35. Edoardo A. Atlas po rekonstruktivnoi khirurgii polovogo chlena. Moscow: ABV-press, 2012. 568 p.

Supplementary files

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2. Fig. 1. Regression function characterizing the dependence of the standing pressure indicator before and after endosphincteroplasty

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3. Fig. 2. Regression function characterizing the dependence of the length of standing compression after endosphincteroplasty on the length of standing compression before endosphincteroplasty in patients with myelodysplasia

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4. Fig. 3. Analysis results after treatment of patients with myelodysplasia following endosphincteroplasty: а — intraurethral pressure lying down; b — intraurethral pressure standing; с — extent of intraurethral compression lying; d — extent of intraurethral compression standing

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5. Fig. 4. Indicators of intraurethral pressure (а) and extent of intraurethral compression depending on the indicator result (b)

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6. Fig. 5. Agenesia of the sacrum (tailbone). The function and outflow from the kidneys are not impaired

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7. Fig. 6. Patient, 15 years old, with myelodysplasia: a — intravesical pressure with natural filling; b — retrograde cystomanogram. Pabd — abdominal pressure, cm of water column; Pves — vesical pressure, cm of water column; Pdet — detrusor pressure, cm of water column; Vura — urine volume, ml; VH2O — is the volume of injected liquid (water), mL

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8. Fig. 7. Patient, 15 years: a — urethral profilometry before endoplasty; b — orthostatic urethral profilometry stresses before endoplasty

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9. Fig. 8. Control orthostatic urethral stress profilometry

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