title: Detrusor compliance changes after bladder neck sling without augmentation in children with neurogenic urinary incontinence.
abstract: OBJECTIVE
  We reviewed preoperative, and initial and final postoperative urodynamic testing in consecutive children undergoing bladder neck sling without augmentation for neurogenic urinary incontinence to determine if progressive loss of compliance occurs.
  
  
  METHODS
  We assessed consecutive patients with neurogenic outlet incompetence who underwent 360-degree tight fascial wrap around the bladder neck with appendicovesicostomy but no augmentation. This population comprised all patients undergoing outlet surgery between 2002 and 2007. Inclusion criteria were initial urodynamic test within 1 year postoperatively and final urodynamic test at least 18 months postoperatively.
  
  
  RESULTS
  A total of 26 patients met inclusion criteria. Most patients (73%) had an acontractile bladder with detrusor pressures less than 25 cm H(2)O preoperatively. Initial postoperative urodynamic test at a mean of 7 months was most predictive of subsequent urodynamic findings. Eight patients (31%) had increased detrusor pressures and/or uninhibited contractions postoperatively. Six patients increased anticholinergic therapy dose. At a mean of 39 months urodynamic patterns were either stable or improved in all patients.
  
  
  CONCLUSIONS
  Progressive compliance loss was not observed after bladder neck sling without augmentation. Postoperative increases in detrusor pressure and/or uninhibited contractions within 1 year postoperatively should prompt review of anticholinergic therapy rather than enterocystoplasty.
authors.affiliation: Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75207, USA. warren.snodgrass@childrens.com
authors.forename: Warren
authors.initials: W
authors.lastname: Snodgrass
authors.forename: Theodore
authors.initials: T
authors.lastname: Barber
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cost
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003187:Compliance; D005260:Female; D006801:Humans; D008297:Male; D009130:Muscle, Smooth / Q000503:physiopathology; D011446:Prospective Studies; D053825:Suburethral Slings; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics