MYOFASCIAL WRAP TO TREAT INTRACTABLE URINARY-INCONTINENCE IN CHILDREN

Objectives. The management of intractable urinary incontinence in the patient with cloacal or bladder exstrophy/epispadias, failed bladder n eck plasty, or failed augmentation cystoplasty remains a surgical chal lenge. The myofascial wrap, a modification of the rectus fascial wrap, was developed to treat intractable urinary incontinence due to sphinc teric incompetence in these problematic cases. A full-thickness, vascu larized pedicle of anterior rectus sheath, rectus abdominis muscle, an d posterior rector sheath is incorporated into a bladder neck wrap to provide support, mucosal coaptation, and active muscular tone. Methods . Eight patients (5 females and 5 males) with total urinary incontinen ce due to sphincteric incompetence underwent the myofascial wrap. Urin ary tract pathology included cloacal exstrophy (2), female epispadias (2), classic bladder exstrophy (1), male epispadias (1), myelomeningoc ele (1), and a pelvic tumor (1). The procedure is performed by harvest ing a full-thickness strip of pedicled rectus muscle along with the an terior and posterior fascial sheaths. The strip is passed underneath a nd then over the bladder neck in a near 360 degrees wrap. The free end of the wrap is anchored into the pubic bone in an ipsilateral subperi osteal pouch. Results. Six of the 8 patients are completely continent, and 2 patients void spontaneously without the need for catheterizatio n. Conclusions. The myofascial wrap provides support, mucosal coaptati on, and muscular tone to an incompetent sphincter and bladder neck. Fa vorable results in a very difficult population of pediatric patients w arrant its continued use. (C) 1998, Elsevier Science Inc. All rights r eserved.