The Pippi Salle Procedure for Neurogenic Urinary Incontinence in Childhood: A Three-Year Experience

Abstract

Aim: A three-year retrospective study was performed to assess the place of the Pippi Salle bladder neck repair in the treatment of neurogenic bladder incontinence in both sexes in childhood.

Method: All children who underwent the procedure between November 1995 and November 1998 were studied retrospectively. There were 18 children: 12 with spina bifida, 5 with sacral agenesis and 1 with an idiopathic neurogenic bladder. There were 11 boys and 7 girls. Their age was 3-14 years (median 7 years) and the length of follow-up was 7 months to 3 years (median 2 years). A midline bladder wall flap was fashioned in all patients. The procedure was performed alone (n = 5) or in combination with a sigmoid colocystoplasty (n = 9) or a Mitrofanoff catheterisable stoma (n = 2) or both (n = 2).

Results: Diurnal continence (3 hours or more) was achieved in 11 of the 18 children (61%); 2 are dry for 2-2.5 hours and 5 are incontinent. Eight of the 18 children (44%) are completely dry during the night, 2 are damp and 8 are incontinent. Twelve children (67%) needed oxybutynin to maintain a good result. Complications arose in 5 children (28 %): difficulty with catheterisation (n = 4) and pelvic abscess (n = 1). Seven children (39%) subsequently required further operations: exploration of bladder for urine leak (n = 2), reinsertion of dislodged catheter (n = 1), drainage of pelvic abscess (n = 1), bladder neck injection with macroplastique (n = 1) and bladder neck closure (n = 2).

Conclusions: The Pippi Salle bladder neck repair has an undoubted place in the management of neurogenic urinary incontinence in childhood. However, in our experience, it has a relatively high complication rate and failure rate.

Key words

Bladder neck - Urethral lengthening - Neurogenic - Child - Urinary incontinence