MODIFICATIONS OF AND EXTENDED INDICATIONS FOR THE PIPPI-SALLE PROCEDURE

Total urinary incontinence is a difficult problem faced by the urologi st. Several techniques to increase ureteral resistance have been descr ibed. The majority of them rely on intermittent catheterization for bl adder emptying, especially in neurogenic incontinence. We have develop ed a new procedure in which a bladder flap is used to create a neouret hra. This urethral extension acts as a flap valve to provide continenc e. Bladder emptying is accomplished by clean intermittent catheterizat ion. Urethral lengthening with an anterior bladder-wall flap was perfo rmed in 18 patients aged a mean of 8.9 years who had neurogenic incont inence (14) or exstrophy (4). Patients with previous bladder intervent ions received a lateralized anterior flap. Bladder augmentation was pe rformed in 14 of the 18 patients [detubularized ileum (11), detubulari zed colon (3)]. The average follow-up period is currently 29.3 months. Continence was achieved in 13 of the 18 patients (72%). Complications included urethrovesical fistulae, which developed in two patients. Tw o patients could not perform catheterization due to pain but had no ob struction to passage of catheter (exstrophy). Ureteral lengthening wit h an anterior bladder-wall flap is a useful alternative for the surgic al treatment of urinary incontinence. This technique achieves a good c ontinence rate and presents few problems with catheterization.