Expanded PTFE bladder neck slings for incontinence in children: the long-term outcome.
OBJECTIVE
To assess the long-term outcome of circumferential expanded PTFE (Gore-tex, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder.


METHODS
The records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore-tex sling placed circumferentially at the bladder neck, over a 5-year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak-point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization.


RESULTS
Full details of the follow-up were available in 17 patients. Despite initial good short-term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one.


CONCLUSIONS
Although in the short term this technique had favourable results, it was not a useful technique in the long term.
Godbole
P
P
Department of Paediatric Urology, Sheffield Children's NHS Trust, Sheffield, UK. prasadgodbole@btinternet.com
Mackinnon
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AE
D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*
D011138:Polytetrafluoroethylene