Colposuspension in girls: clinical and urodynamic aspects.

OBJECTIVES

To investigate the effect of colposuspension on bladder function and urinary incontinence in girls with structural stress incontinence.

PATIENTS AND

METHODS

A Burch colposuspension was performed in 26 incontinent girls for congenital bladder neck insufficiency (10), incontinence after urethrotomy (seven), hypospadias (five) and ectopic ureterocele (four). The indication for surgery was failure of conservative therapy (consisting of cognitive and biofeedback bladder training, physical therapy and/or antimuscarinic drugs in 23 children) and a severe anatomical defect of the bladder outlet in three. Colposuspension was combined with reconstruction of the distal urethra in three patients and of the bladder neck in seven. All girls had urodynamic tests before and after colposuspension.

RESULTS

After surgery 14 of the 26 patients (54%) were completely dry, four (15%) had improved and eight (31%) still had incontinence requiring pads. In 17 patients (65%) additional conservative therapy was given and three (12%) had additional surgery. After a median follow-up of 62 months, 65% were completely dry, 19% had improved and 15% were incontinent. Of 25 patients who had recurrent urinary tract infections before colposuspension, 14 had none afterwards. Bladder overactivity in 10 patients before colposuspension resolved in five and de novo overactivity was detected in four.

CONCLUSIONS

In a selected group of girls with structural urinary incontinence, Burch colposuspension can be used when medical treatment, cognitive and biofeedback bladder training fail. It is reasonably effective for resolving incontinence and safe for bladder function.