Rectus Fascial Sling for Treating Neurogenic Sphincteric Incontinence in Boys with Spina Bifida

Lee, Sang Wook; Kim, Kwang Myung

Abstract

PURPOSE: To evaluate the long-term efficacy and safety of a rectus fascial sling for the treatment of neurogenic sphincteric incontinence in boys with spina bifida.
MATERIALS AND METHODS
Between June 1993 and January 2000, 9 boys with myelodysplasia underwent placement of a fascial sling around the bladder neck for the treatment of severe urinary incontinence. Concurrent augmentation cystoplasty and sling cystourethropexy were performed in 8 boys, and the other had been augmented previously. The mean age of the boys was 9.8 years, ranging from 6 to 14 years, and the mean follow-up was 44.4 months, ranging from 1 to 115 months. The continence states and complications were examined after rectus fascial sling placement, and the pre- and post-operative urodynamic findings analyzed.
RESULTS
At the last follow up, 4 of the 9 patients had remained completely dry, and one partially dry. Therefore, the overall success rate was 55.5% (5/9). 2 of the 4 who failed to achieve continence still depend on pads, with the other two receiving a finally bladder neck closure. There was no postoperative complication associated with sling procedure itself, and no patient had postoperative upper tract deterioration. Postoperative urodynamic evaluation revealed normal bladder compliance. However, the fascial sling had variable effects on the maximum urethral closure pressure.
CONCLUSIONS
It seems that a rectus fascial sling, as a primary treatment of neurogenic sphincteric incontinence, in boys with spina bifida is safe, but its success can not always be guaranteed; therefore, efforts will be required to increase the success rate.