EVALUATION AND TREATMENT OF INCONTINENCE AFTER BLADDER NECK RECONSTRUCTION IN EXSTROPHY AND EPISPADIAS

Twenty-five children with exstrophy/epispadias who had had at least on e bladder neck operation (but no augmentation) for incontinence underw ent cystometrography (CMG) and urethral pressure profile (UPP) studies , The purpose of this study was to examine all components of lower uri nary tract function and to determine how the properties of the bladder and the properties of the bladder neck/urethra interacted to achieve continence or to result in incontinence in the individual child. Exami nation of detrusor function during filling revealed involuntary contra ctions in 12 children and an end-fill pressure > 10 cm H2O in 8. Of th e 21 children in whom voiding could be evaluated only 6 could initiate a detrusor contraction. In the 18 incontinent children leak pressure could be measured and was greater-than-or-equal-to 15 cm H2O in 12. Fi ve of the 7 continent children also demonstrated at least one abnormal ity in lower tract function. The maximum pressure of the UPP did not a gree with the leak pressure and may not be a valid measure of the clos ing pressure of the bladder neck/urethra in this patient population. D etailed urodynamic investigation is necessary in these children to gui de the next step of management and to evaluate objectively each form o f treatment.