Expanded PTFE bladder neck slings for incontinence in children: the long‐term outcome

Abstract

OBJECTIVETo assess the long‐term outcome of circumferential expanded PTFE (Gore‐texTM, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder.PATIENTS AND METHODSThe records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore‐tex sling placed circumferentially at the bladder neck, over a 5‐year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak‐point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization.RESULTSFull details of the follow‐up were available in 17 patients. Despite initial good short‐term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one.CONCLUSIONAlthough in the short term this technique had favourable results, it was not a useful technique in the long term.

Current Concepts in Female Neurogenic Voiding Dysfunction

“…Bladder neck pubovaginal slings (with or without bladder reconstruction) provide reasonable success rates [60]. The autologous fascial sling is most appropriate due to the increased risk of urethral erosion with an obstructing synthetic sling [61][62][63]. The synthetic bladder neck sling is no longer recommended in this population due to the high erosion rates.…”

Silk Fibroin Scaffolds for Urologic Tissue Engineering

“…These biomaterials have also been associated with in vivo fibrosis and contracture [32]. Synthetic biomaterials in the form of 3D porous foams, meshes, and hydrogels derived from poly-glycolic acid (PGA), poly-L-lactic acid (PLA), copolymers of poly-lactic and -glycolic acid (PLGA) [33–37]; PTFE Teflon [38]; polyether urethane [39]; silicone rubber [40]; and poly(ethylene) glycol (PEG) [41] have also been utilized as platforms for bladder reconstructive strategies. However, permanent synthetic biomaterials routinely demonstrate in vivo mechanical failure and urinary stone formation and thus are limited in clinical applications [42].…”