Surgical management of urinary incontinence in children with neurogenic sphincteric incompetence

Purpose: There are many alternatives for the surgical treatment of children with neurogenic sphincteric incompetence. However, there is no consensus r egarding appropriate evaluation and long-term management in these patients. We critically reviewed the literature and compare the outcomes of each tec hnique. Materials and Methods: A MEDLINE search was performed to select all relevan t peer reviewed publications since 1966. In addition, the bibliography of e ach article was examined for additional published resources. The results of each technique were compared in 7 objective categories, including continen ce (defined as complete dryness for 4 hours between voidings or catheteriza tions), the need for intermittent catheterization, effects on bladder compl iance, the need for bladder augmentation, upper tract changes, other compli cations and the revision rate. Results: Long-term results of artificial urinary sphincter placement were s uperior and reproducible in terms of continence, preservation of volitional voiding and avoidance of bladder augmentation. Revision rates of various p rocedures were similar but the incidence of complications was highest with the Kropp procedure. Long-term published data were limited in regard to bla dder neck sling, reconstruction, injection, suspension and urethral lengthe ning techniques. Conclusions: Long-term published data support artificial urinary sphincter creation as first line surgical management of neurogenic sphincteric incont inence. Girls who already depend on intermittent catheterization may benefi t equally from a sling procedure if successful long-term continence is demo nstrated in future studies.