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S21-8
(PP)
OPEN AND LAPAROSCOPIC BLADDER NECK SUSPENSION IN CHILDREN WITH
REFRACTORY URINARY INCONTINENCE BASED ON BLADDER NECK
INSUFFICIENCY
Rafal CHRZAN
1
, Luitzen Albert GROEN
2
and Tom P.M.V. DE JONG
3
1) University Childrens' Hospital AMC, Pediatric Urology, Amsterdam, NETHERLANDS - 2) Universty Hospital, Pediatric
Urology, Gent, BELGIUM - 3) University Childrens' Hospital UMC-Utrecht and AMC-Amsterdam, Pediatric Urology,
Utrecht, NETHERLANDS
PURPOSE
To present the results of open and laparoscopic (lap) colposuspension in children.
MATERIAL AND METHODS
18 open and 18 lap consecutive procedures with a follow up > 1 year were analysed. All patients had urinary
incontinence (UI). In 39% constipation was treated. 8/18 in open and 6/18 in lap group had history of recurrent UTI’s.
All patients failed urotherapy for at least 3 years. Bladder neck insufficiency was proven by repeated perineal ultrasound
and video-urodynamic study. The lap procedure was performed preperitoneally by means of three 5-mm ports, and the
open one via a transverse lower abdominal incision. The anterior wall of the vagina, lateral to the bladder neck, was
mobilized and bilaterally sutured to Cooper’s ligament. The same postoperative protocol was used. The mean age was
11.5 and 13.5 years (open vs lap). The Fisher’s exact test was used for the statistical analysis.
RESULTS
The mean operation time was 65 min for the open and 90 min for the lap procedure. Intraperitoneal CO
2
leakage
occurred in 1 patient without need for conversion. 2 patients in open and 1 in lap group needed temporary CIC due to
urinary retention. Full success (dryness) was achieved in 7/18 in open and in 8/18 in lap group and partial response was
seen in 2/18 and in 5/18, respectively (p=0.64). 66% in both groups were free of UTI’s and antibiotic prophylaxis was
ceased.
CONCLUSIONS
Both open and laparoscopic colposuspension can be used to treat refractory UI in children with bladder neck
insufficiency when non-invasive methods fail. Laparoscopy can be preferable by the patient due to a superior cosmesis.