The treatment of post-urethrotomy incontinence in pediatric and adolescentfemales

Purpose: Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infec tion in girls. We describe the results of therapy in patients who became in continent due to previous internal urethrotomy. Materials and Methods: Between 1986 and 1995, 21 female patients with post- Otis urethrotomy incontinence have presented at our department with combine d dysfunctional voiding, recurrent urinary tract infection and various type s of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video u rodynamics and ultrasound of the open bladder neck. Endoscopy provided proo f of scarring in the bladder neck and urethra. All patients except I underw ent conservative treatment for at least 2 years, consisting of pharmacologi cal therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burc h-type colposuspension in 5, modified needle colposuspension in 4 and compl ete endoscopic excision of the urethral scars followed by open reconstructi on of the bladder neck and urethra in an abdominoperineal procedure in 5. Results: Conservative treatment has been completely successful in 7 patient s. Primary open or needle colposuspension was unsuccessful in 6 of 9 cases, including several requiring further surgery to achieve dryness. The result s of excising urethral scars with bladder neck and urethral reconstruction were good in 4 of 5 patients at a followup of at least 4 years. Conclusions: When previous internal urethrotomy appears to be an important factor in the evaluation of incontinence, conservative therapy is the treat ment of choice. Conservative therapy should consist of biofeedback reeducat ion of the voiding pattern and physical therapy. When surgery is needed, ex cision of the urethral scars with reconstruction of the bladder neck and ur ethra plus colposuspension is superior to colposuspension only.