The rectus myofascial wrap in the management of urethral sphincter incompetence.
OBJECTIVE
To review our experience with a modified rectus/pyramidalis myofascial sling, described more than a century ago for treating refractory urinary incontinence in children with neurogenic sphincteric incompetence.


METHODS
Thirty-seven patients (23 females and 14 males, aged 8-21 years) presented with urinary incontinence which failed to respond to medical treatment. In 36 patients the cause of the incontinence was a neurogenic bladder; one patient had sustained a traumatic injury to the bladder neck and urethra. Patient selection was based on videocysto-urethrographic detection of an incompetent bladder neck, and a low maximum closure pressure during urethral pressure profilometry. The bladder was augmented in 33 of the 37 patients.


RESULTS
Of the 37 patients, 34 (92%) are dry between catheterizations; the follow-up was 0.5-10 years. Two of the male patients continued to have persistent incontinence requiring bladder neck closure and creation of a continent stoma. One of the female patients developed stress incontinence after 4 years of being dry, with a rectus sling.


CONCLUSIONS
The rectus myofascial sling provides long-term satisfactory dry intervals between catheterizations in patients with neurogenic sphincteric incompetence. The cinch-wrap modification appears to enhance the occlusive effect of the sling, particularly in males.
Mingin
G C
GC
Children's Hospital of New Jersey, St. Barnabas Health Care System, University of Medicine and Dentistry of New Jersey-New Jesrey Medical School, Newark, USA. Gmingin@aol.com
Youngren
K
K
Stock
J A
JA
Hanna
M K
MK
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000293:injuries; D001750:Urinary Bladder, Neurogenic / Q000150:complications; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*