OUTCOME OF SLING CYSTOURETHROPEXY IN THE PEDIATRIC POPULATION - A CRITICAL-REVIEW

Purpose: We performed a critical retrospective analysis of the records of all consecutive children who underwent sling cystourethropexy at o ur institutions. We particularly assessed the incidence and outcome in children who underwent enteracystoplasty in addition to a sling proce dure. Materials and Methods: Between May 1992 and August 1994, 24 girl s and 15 boys 4 to 17 years old (mean age 9) consecutively underwent 1 of 4 techniques of sling cystourethropexy for stress urinary incontin ence using rectus fascia via an abdominal approach. Diagnoses included spinal dysraphism in 34 patients, spinal trauma in 2, cecoureterocele in 1, epispadias in 1 and classic bladder exstrophy in 1. All childre n underwent preoperative video urodynamics. In 4 patients only a sling procedure was performed (group 1), while in 9 others a sling procedur e was performed after enterocystoplasty (group 2). In 26 patients a sl ing procedure and concomitant enterocystoplasty were performed (group 3). Results: Patients who underwent concomitant enterocystoplasty had more hyperactive preoperative urodynamics than those who did not, Post operative continence was subcategorized in terms of patient age, sex, diagnosis (neurogenic versus nonneurogenic), preoperative video-urodyn amics, surgeon technique, group (that is with or without cystoplasty) and type of enterocystoplasty (that is stomach versus ileum). Of these factors only concomitant enterocystoplasty was predictive of postoper ative dry continence (73% of group 3, 33% of group 2 and 25% of group 1). In most patients who were not dry postoperative video urodynamics suggested suboptimal outlet resistance overcome by a hyperactive detru sor. No patient had postoperative upper tract deterioration. Conclusio ns: These results suggest that concomitant enterocystoplasty should be critically considered for pediatric patients undergoing sling cystour ethropexy.