Abstract General Information

Title

BLADDER SURGERY (AUGMENTATION AND BLADDER NECK TIGHTENING) IS REQUIRED FOR ACHIEVING ADEQUATE SOCIAL CONTINENCE IN THE MANAGEMENT OF NEUROGENIC BLADDER – IT IS SEEMINGLY MUCH UNDERPERFORMED IN THE WORLD TODAY - A VIEWPOINT

Introduction and objective

Making children with NGB socially continent, helps significantly in improving their quality of lives. This means making them dry enough to conveniently manage all their vocational and avocational activities. Making them adequately dry means being able to hold urine without leakage for a period of 3 hours or even more. Dry intervals of less than 2 hours would not make them sufficiently socially continent.
Medical management of NGB, in most cases, only results in making children who were continuously dribbling, achieve a dry interval of up to 11/2 – 2 hours. To achieve dry intervals of 3 hours or more, surgical management is required.
In many parts of the world (the author has personally interacted with patients and families from all over the world), patients (mostly above 10 yrs) who have been offered only medical management for their incontinence are not happy with their dry intervals and desire longer dry intervals – which can be possible only by surgery.

Method

50 cases of nurogenic bladder (NGB) due to Spina Bifida were managed by us first medically (CIC and Anticholinergics) and then with additional surgery (Augmentation with or without Bladder neck tightening) when dry intervals of more than 2 hours were not achieved. Of the 50 cases, only in 8 cases dry intervals of more than 2 hours were achieved by medical management alone. The 42 other cases underwent Bladder surgery (Augmentations in 40, Bladder neck slings in 28, Mitrofanoff in 42). All the patients had a minimum follow up of at least 4 years post-surgery.

Results

Only in 8 cases managed by medical treatment alone, dry intervals of more than 2 hours were achieved (2 – 3hours). In almost all the operated cases (39 out of 42 operated cases) dry intervals of more than 3 hours were achieved (3 – 6 hours). In three operated cases dry intervals remained less than 3 hours (11/2 – 2 hours). The operated cases remained dry for more than 3 hours on follow up for more than 4 years.

Conclusion

Medical management of NGB related urinary incontinence usually does not achieve adequate social continence (dry interval of more than 3 hours) and Surgical management is required to enable achievement of dry intervals more than 3 hours (3-6 hours).
In many parts of the world, Bladder surgery is not offered to patients who seek longer dry intervals. Thus, it may be said that Bladder surgery for incontinence in NGB cases is seemingly a much-underperformed operation in the world.