The use of rectus fascia to manage urinary incontinence

S. B. Bauer, Craig A Peters, A. H. Colodny, J. Mandell, A. B. Retik

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

The surgical management of urinary incontinence in children is one of the most difficult challenges facing pediatric urologists today. We have critically looked at our experience using a rectus fascial sling to prevent incontinence. Eleven girls (6 to 22 years old) with urinary incontinence from neurogenic bladder dysfunction (9), surgical injury to the bladder (1) or urogenital sinus abnormality (1) comprise this study. All had failed regimens of pharmacological therapy and intermittent catheterization. Three patients had undergone prior bladder neck reconstruction and 2 an augmentation cystoplasty in an attempt to control the incontinence. Urodynamic studies revealed several reasons for the continued wetting in these individuals: a changing neurological lesion leading to a loss of innervation and concomitantly lowered urethral resistance in 2 patients, adequate urethral resistance at rest but decreasing resistance with bladder filling in 4, no increase in urethral resistance with increases in abdominal pressure in 4 and urethral instability (a decrease in resistance following a cough or Valsalva's maneuver) in 1 apparently neurologically normal girl. Eight patients are dry 3 to 24 months postoperatively on intermittent catheterization. All have demonstrated either an increase in urethral resistance at rest or an adequate level of resistance during filling of the bladder or a sudden increase in abdominal pressure. Of the remaining 3 patients 1 is dry for 2 to 3 hours but then leakage occurs, 1 is improved but damp and 1 patient is wet 3 months postoperatively. The use of rectus fascia to improve outlet resistance seems to be a viable alternative in the management of incontinence in selected female subjects.

Original languageEnglish (US)
Pages (from-to)516-519
Number of pages4
JournalJournal of Urology
Volume142
Issue number2 II
DOIs
StatePublished - 1989

ASJC Scopus subject areas

  • Urology

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    Bauer, S. B., Peters, C. A., Colodny, A. H., Mandell, J., & Retik, A. B. (1989). The use of rectus fascia to manage urinary incontinence. Journal of Urology, 142(2 II), 516-519. https://doi.org/10.1016/s0022-5347(17)38801-8