Refractory Urinary Incontinence in Girls: The Role of the Bladder Neck

Abstract

BackgroundPrevalence of lower urinary tract dysfunction (LUTD) in children is between 6 and 9% with urinary incontinence (UI) being one of the most common symptom.Various aspects of lower urinary tract symptoms (LUTS)Anatomical anomalies of the urinary tract as well as neurogenic underlying pathology can results in LUTS. Comorbidities and long-term consequences of the LUTD for the female patients as well as genetic issues are also briefly discussed.The role of the bladder neckThanks to urodynamics, we have learnt a lot about the lower urinary tract function, but the role of the bladder neck in the pathophysiology of LUTS in children is not clear. Secondary bladder neck hypertrophy is a well-described pathology, but there is no standardized treatment for this phenomenon. Primary bladder neck dysfunction has already been defined by the International Children’s Continence Society.Refractory UI in girlsUniform diagnostic protocols are used in these girls with UI. Treatment consists of standard urotherapy, additional interventions, and pharmacotherapy in selected cases. Those with refractory UI require careful reassessment to look for the unrecognized disorders. Invasive urodynamics should be done in those patients. Ultrasound of the bladder neck region and the pelvic floor can be helpful, but its interpretation is very subjective. In a small group bladder neck insufficiency can be found and those might benefit from a surgical intervention.Future perspectiveStrict criteria of the bladder neck insufficiency in children must be defined. Early surgical intervention in girls with bladder neck insufficiency might reduce the long period of intensive conservative treatment.

Open and Laparoscopic Colposuspension in Girls with Refractory Urinary Incontinence

“…A small series showed that 50–75% of girls with refractory UI and insufficient bladder neck can be cured by a colposuspension procedure ( 3 , 9 , 10 ).…”

“…Objective criteria to decide which patients will benefit most from colposuspension should be provided in the future. These criteria could be established based on patient characteristics, clinical symptoms, and additional tests e.g., UI, symptoms of bladder overactivity, bladder capacity, recurrent UTIs, and objective data from perineal ultrasonography/video-urodynamics ( 10 ).…”