Endoscopic treatment of sphincteric urinary incontinence in by yurtgc548

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									       Endoscopic treatment
 of sphincteric urinary incontinence
         in pediatric urology
Hamdan AlHazmi, Diego Barrieras, Cédric Andres,
  Julie Franc-Guimond and Anne-Marie Houle

  Division of Pediatric Urology, Department of
  Surgery, CHU Sainte-Justine, Université de
           Montréal, Québec, Canada.
                  Introduction
   Type III urinary incontinence present dificult
    problem in pediatric urology due to its various
    etiologies
   Since 30 years surgical and medical treatment
    considerably advanced
   In spite of the combination of CIC,
    anticholinergic and various surgical operations,
    certain patients remain incontinent
                 Introduction
   The endoscopic treatment has the advantage of
    being minimally invasive and possible even after
    multiple vesical/ ureteral reconstructions

   We present our results with the endoscopic
    correction of the type III incontinence using
    Polydimethylsiloxane (Macroplastic®,Uroplasty
    Inc.)
            Material and Methods
   Retrospective study
   14 patients
   10 boys and 4 girls
   8-13 years
   Inclusion criteria:
       Incontinence of the type III pure or mixed
       Leak point pressure LPP<20 cmH20
       Failure of the medical and/or surgical treatment
              Material and Methods
   The surgical technique:
       Injection under direct
        vision in 3points (2,6 and
        10 hours or 4,8 and 12
        O'clock)
       Level of injections:
            Girls: Bladder neck
            Boys: external sphincter or
             posterior urethra
           Material and Methods

   Follow up:
       Renal U/S and UDS: 3 and 12 months
       Diary for CIC and Pad/ Diaper
           Material and Methods

   Success rate definition:
       From ≥2 Diaper/day to ≤2 pads/day
       Increase the period of continence(x2)
                        Results
   14 patients
       8   MMC
       4   Bladder Exstrophy
       1   Cloacal Exstrophy
       1   Urogenital sinus anomaly
    24 Procedures
   Volume injected : 1,5 - 5 ml
                     Results…
•Disease specific success rate:

      100   88%
       90
       80
       70
       60              50%
       50
       40
       30
       20
       10
                                           0                   0
        0
            MMC    Bladder Exstrophy   Cloacal Exstrophy   urogenital sinus
                                                              anomalies
                       Results
•Total success rate



      100

       80      64.2%

       60                    35.8%
       40

       20

        0
              Success            failure
                                                    Results…
 •LPP Pre and Post Injection:

LPP (cmH20)
     90
     80
     70
     60
     50             67
                             51                60                          50                                    49
     40                                                  53                                   56
           46
     30                               45
     20                                                           15
                                                                                     16                12                 17
                                                                                                                                   10
     10    12
                    18       20                15        13       12
                                                                           19
                                                                                              13       10
                                                                                                                 19
                                                                                                                          10
                                       8                                              8                                             8
      0
          patient patient   patient patient   patient   patient patient   patient   patient patient   patient   patient patient   patient
            #1      #2        #3      #4        #5        #6      #7        #8        #9     #10       #11       #12     #13       #14
                     Results…
•Leak point pressure (LPP) cmH20



     50                        39.1
     40
     30
     20      13.2
     10
      0
             Pre-injection     Post-injection
                       Results…
•Complications


      100%
       90%                                  86.0%
       80%
       70%
       60%
       50%
       40%
             21.4%         14.3%
       30%
       20%
       10%
        0%
                 UTI     Hydronephrosis   temporary deficulty
                                              with CIC
                Conclusions
   The endoscopic treatment of type III
    incontinence is offers another option in
    armentarium of the paediatric urologists
   The procedure is relatively simple
    ,minimally invasive and Safe
   The short-term results are encouraging
   Long-term results with large cohort are
    necessary

								
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