Myofascial wrap to treat intractable urinary incontinence in children

Mark E. Kolligian*, Lane S. Palmer, Earl Y Cheng, Casimir F. Firlit

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objectives. The management of intractable urinary incontinence in the patient with cloacal or bladder exstrophy/epispadias, failed bladder neck plasty, or failed augmentation cystoplasty remains a surgical challenge. The myofascial wrap, a modification of the rectus fascial wrap, was developed to treat intractable urinary incontinence due to sphincteric incompetence in these problematic cases. A full-thickness, vascularized pedicle of anterior rectus sheath, rectus abdominis muscle, and 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 3 males) with total urinary incontinence due to sphincteric incompetence underwent the myofascial wrap. Urinary tract pathology included cloacal exstrophy (2), female epispadias (2), classic bladder exstrophy (1), male epispadias (1), myelomeningocele (1), and a pelvic tumor (1). The procedure is performed by harvesting a full-thickness strip of pedicled rectus muscle along with the anterior and posterior fascial sheaths. The strip is passed underneath and then over the bladder neck in a near 360°wrap. The free end of the wrap is anchored into the pubic bone in an ipsilateral subperiosteal pouch. Results. Six of the 8 patients are completely continent, and 2 patients void spontaneously without the need for catheterization. Conclusions. The myofascial wrap provides support, mucosal coaptation, and muscular tone to an incompetent sphincter and bladder neck. Favorable results in a very difficult population of pediatric patients warrant its continued use.

Original languageEnglish (US)
Pages (from-to)1122-1127
Number of pages6
JournalUrology
Volume52
Issue number6
DOIs
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Urology

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