f.9 what is the safety and efficacy of urethral tape and ... · therapy and clean intermittent...

Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease

309 Urinary incontinence in neurological disease – appendices

F.9 What is the safety and efficacy of urethral tape and sling surgery compared with usual care in neurological disease?

Reference

Study type

Evidence level

Number of patients Patient characteristics Intervention Comparison

Length of follow-up

Outcome measures

Source

of

funding

Abdul-Rahman A, Attar KH, Hamid R et al. Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders. BJU Int. 2010; 106(6):827-830. Ref ID: ABDULRAHMAN2010

Details as for Hamid R, Khastgir J, Arya M et al. Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders. Spinal Cord. 2003; 41(2):118-121. Ref ID: HAMID2003

Mean 10 yrs

Continence

Health-related quality of life

None reported



Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding

Effect

Pre-surgery Post-surgery

Continence 0/12 implied – 5 yr follow up

0/9 implied – 10 yr follow up

10/12

7/9

Health-related quality of life ‘satisfied’ -

-

11/12 5 yrs

9/9 10 yrs

Reference Study type

Evidence level

Number of patients

Patient characteristics Intervention Comparison Length of follow-up

Outcome measures

Source

of

funding

Albouy B, Grise P, Sambuis C et al. Pediatric urinary incontinence: evaluation of bladder wall wraparound sling procedure. Journal of Urology. 2007;

Prospective observational study

N=14 Patients with neurogenic bladder resulting from spinal dysraphism

Patient population: mean age 14 yrs (range 8 to 22 yrs)

Incontinent despite anticholinergic therapy and clean intermittent catheterisation

7 females and 7 males

Bladder wall wraparound sling procedure

Plus bladder augmentation

Pre surgery Mean 5 yrs (range 2 to 8 yrs)

Continence

Urinary tract infections

Problems with long term catheterisation

None reported



177(2):716-719. Ref ID: ALBOUY2007

Effect


Continence 0/14 13/14 (results very good or good)

Urinary tract infections - 0/14

Problems with catheterisation - 0/14

Reference

Study type

Evidence level Number of patients Patient characteristics Intervention Comparison

Length of follow-up

Outcome measures

Source

of

funding

Austin PF, Westney OL, Leng WW et al. Advantages of rectus fascial slings for urinary incontinence in children with neuropathic bladders. Journal of Urology. 2001; 165(6 Pt 2):2369-

Retrospective observational study

N=18 Children with neuropathic bladder secondary to myelodysplasia or traumatic spinal cord injury

Patient population: mean age 14 yrs (range 8 to 18 yrs), myelodysplasia n=16

8 males:10 females

Fascial sling surgery

Pre-surgery Mean 21.2 mths

Continence

Repeat surgery

None reported



2371. Ref ID: AUSTIN2001

Effect


Continence 0/18 implied 14/18

Reoperation to repair sling - 2/18

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Barthold JS, Rodriguez E, Freedman AL et al. Results of the rectus fascial sling and wrap procedures for the treatment of neurogenic sphincteric incontinence. Journal of Urology. 1999; 161(1):272-274. Ref ID: BARTHOLD1999


N=27 Children with neurogenic sphincter incontinence

Patient population: Myelomeningocele 21/27

7 boys and 20 females

Rectus fascial sling (N=10 procedures) and wrap (N=18 procedures) (one patient underwent both procedures)

N=22 bladder augmentation

Pre-surgery Minimum 1 yr

Continence (completely dry day and night)

Difficulty with catheterisation

None reported

Effect

Sling (N=10 procedures) Wrap (N=18 procedures)

Pre-surgery Post-surgery Pre-surgery Post-surgery

Continent 0/10 implied 5/10 (completely dry) 0/18 5/18 (completely dry)



Difficulty with catheterisation - 0/10 - 0/18

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Bauer SB, Peters CA, Colodny AH et al. The use of rectus fascia to manage urinary incontinence. Journal of Urology. 1989; 142(2 Pt 2):516-519. Ref ID: BAUER1989

Retrospective observational study.

N=11 All female. Age range 6-22 yrs (mean 14 yrs).

All had urinary incontinence. Underlying cause of incontinence was myelodysplasia ( 8), sacral agenesis (1) and non-neurogenic etiology (2).

3 had undergone prior bladder neck reconstruction, and 2 had previous augmentations.

Rectus fascia sling

4/11 underwent augmentation (plus n=2 had previous augmentation)

None. Pre-op to post-op was compared.

3-24 months (mean 12 months)

Continence

Adverse events

Not stated.

Effect


Continence 0/11 8/11 completely continent on IC

1/11 dry for 2-3 hrs between IC, but leakage with vols of >250cc.

2/11 improved but damp

Adverse effects (perioperative or late) 0/11

Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding



Bugg CE, Jr., Joseph DB. Bladder neck cinch for pediatric neurogenic outlet deficiency. Journal of Urology. 2003; 170(4 Pt 2):1501-1503. Ref ID: BUGG2003


N=15 Children with neurogenic intrinsic sphincter deficiency and a poorly compliant and/or small capacity bladder

Patient population: 14/15 female 1/15 male

Sling (rectus fascia) applying circumferential pressure

All patients underwent ileal augmentation

Pre-surgery 10 to 36 mths

Continence (dry between catheterisation and dry at night)

None reported

Effect


Continence 0/15 9/15 (completely dry)

Difficulty with catheterisation - 0/15

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Castellan M, Gosalbez R, Labbie A et al. Bladder neck sling for treatment of neurogenic


N=58 Patients with neurogenic bladder.

Criteria: a detrusor leak point pressure of less than 45 cm H2O, an open bladder neck during bladder filling at low detrusor pressure and clinical evidence of stress incontinence.

Patient population: 43 females, 15 males,

Rectus fascial sling neck procedure

All patients underwent bladder

Pre-surgery Mean 4.16 (range 1 to 10 yrs)

Continence

Upper tract deterioration

Bladder neck occlusion

None reported



incontinence in children with augmentation cystoplasty: long-term followup. Journal of Urology. 2005; 173(6):2128-2131. Ref ID: CASTELLAN2005

median age 11.4 yrs (range 4 to 40 yrs). Spina bifida 52/58

augmentation

Effect



Upper tract deterioration - 0/58

Bladder neck occlusion - 2/58

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Daneshmand S, Ginsberg DA, Bennet JK et al. Puboprostatic sling repair for treatment of urethral incompetence in


N=12 Males with neurogenic bladder due to spinal cord injury (n=9) and spina bifida (n=3)

Autologous fascial sling (rectus fascia)

10/12 underwent simultaneous

Pre-surgery Mean 14.25 (1 to 39 mths)



adult neurogenic incontinence. Journal of Urology. 2003; 169(1):199-202. Ref ID: DANESHMAND2003

bladder augmentation

Effect


Continence (completely dry) 0/12 8/12 (completely dry)

Complications - 0/12

Difficulty catheterising - 0/12

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Dean GE, Kunkle DA. Outpatient perineal sling in adolescent boys with neurogenic incontinence. Journal of Urology. 2009; 182(4 Suppl):1792-1796. Ref ID: DEAN2009


N=6 Patient population: Patients aged 14 to 20 yrs. History of myelomeningocele. Urodynamics showed normal compliance, adequate capacity and sphincter incompetence.

Previous surgery: 5/6 (1 appendicovesicostomy and bladder augmentation, 4 bladder neck bulking)

6/6 male

Suburethral sling was placed on an outpatient basis through a small perineal incision

Pre surgery Median 33 mths (range 27 to 39 mths)

Continence

Urethral erosion

Re-operation

Need for catheterisation

None reported

Effect





Re-operation - 3/6

Urethral erosion - 0/5*

Need for catheterisation 6/6 5/5*

* one patient had the sling removed and not replaced

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Decter RM. Use of the fascial sling for neurogenic incontinence: lessons learned. Journal of Urology. 1993; 150(2 Pt 2):683-686. Ref ID: DECTER1993


N=10 Patients with neurogenic incontinence

Patient population: 8 patients with meningomyelocele, 2sacral anomalies. Age range 6 to 26 yrs

Fascial sling (n=5 rectus abdominus fasica, n=5 fascia lata)

N=6 underwent bladder augmentation

Pre surgery Mean 2.2 yrs

Continence

Erosion


None reported

Effect

Rectus fascia Fascia lata

Pre-surgery Post-surgery Pre-surgery Post-surgery

Continence 0/5 2/5 long term 0/5 2/5 long term



Erosion 1/10

Transient difficulty with catheterisation 3/10

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Dik P, Klijn AJ, Van Gool JD et al. Transvaginal sling suspension of bladder neck in female patients with neurogenic sphincter incontinence. Journal of Urology. 2003; 170(2 Pt 1):580-581. Ref ID: DIK2003A


N=24 Female patients with spina bifida and neurogenic sphincter paralysis

Patient population: mean age 9 yrs (range 1 to 17 yrs)

Transvaginal sling suspension (rectus fascia)

Adjunct bladder augmentation in a few patients

Pre-surgery Mean 3 yrs (range 0.6 to 11 yrs)

Continence

Infections


Complications

None reported

Effect


Continence 0/24 implied 19/24

Infections - 0/24




Complications - 1/24 (vesicovaginal fistula)

Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding

Dik P, Van Gool JD, de Jong TP. Urinary continence and erectile function after bladder neck sling suspension in male patients with spinal dysraphism. BJU Int. 1999; 83(9):971-975. Ref ID: DIK1999


N=14 Male patients with neurogenic sphincter incontinence and spina bifida

Patient population:mean age 11.7 yrs (range 6.5 to 15.2 yrs)

Puboprostatic sling suspension (recuts fascia)

Simultaneous autoaugmentation of the bladder 8/14

2/14 simultaneous ileocystoplasty

Pre-surgery Not reported

Continence Difficulty with catheterisation

Erectile dysfunction

None reported

Effect


Continence (daytime) 0/14 10/14

Difficult with catheterisation - 2/14

Erectile dysfunction 0/14 1/14

Reference

Study type

Evidence


Length of follow-

Outcome measures

Source

of



level up funding

Elder JS. Periurethral and puboprostatic sling repair for incontinence in patients with myelodysplasia. Journal of Urology. 1990; 144(2 Pt 2):434-437. Ref ID: ELDER1990

N=14 Patients with myelodysplasia undergoing periurethral and puboprostatic sling repair

None had undergone previous bladder neck surgery or augmentation cystoplasty.

All patients had failed pharmacological therapy

Patient population: mean age 12.6 yrs (range 7 to 25 yrs)

10 female: 4 male

Female – periurethral sling using rectus fascia

N=10

Male – puboprostatic sling

N=4

13/14 underwent augmentation cystoplasty

Pre-surgery Mean 12 months (2 to 27 months)

Continence None reported

Effect


Continence 0/14 implied 12/14 (completely dry)

Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding

Fontaine E, Bendaya S,

Prospective observational

N=21 Patients with neurogenic incontinence unresponsive to conservative treatment

Rectus fascial sling procedure

Pre-surgery 28.6 mths

Continence

Asymptomatic

None reported



Desert JF et al. Combined modified rectus fascial sling and augmentation ileocystoplasty for neurogenic incontinence in women. Journal of Urology. 1997; 157(1):109-112. Ref ID: FONTAINE1997

study in whom postoperative volitional voiding was not expected

Patient population: 13 patients with congential lesions, 8 with acquired cord lesions. 21/21 female

and augmentation ileocystoplasty

(range 6 mths to 5 yrs)

bacteriuria

Bladder calculi

Difficulty with catherisation

Effect


Continence 0/21 20/21 daytime

18/21 nighttime

Asymptomatic bacteriuria - 13/21 (4/13 febrile UTI)

Bladder calculi - 0/21


Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Godbole P, Mackinnon AE. Expanded PTFE bladder neck slings for incontinence in


N=19

N=17

(follow-up

Children with a neuropathic bladder who underwent a Gore-tex bladder neck sling procedure. All patients had a poorly compliant bladder,

Gore-tex bladder neck sling

7/19

Pre-surgery Median 7 yrs

Continence

Adverse events

None reported



children: the long-term outcome. BJU Int. 2004; 93(1):139-141. Ref ID: GODBOLE2004

data available)

neurogenic sphincteric weakness with low leak-point pressure. Management consisted of clean intermittent catheterisation, pharmacotherapy and cystoplasty (4/19)

7/19 concomitant bladder augmentation

Patient population: median age 10 (2.5 to 17) yrs. 12 boys and 7 girls. Spina bifida 7/17

concomitant bladder augmentation

Effect

Continence

15/17 (initially dry)

4/17 (dry long term)

Re-operation

14/17 sling removed due to erosion

Complications

No short-term complications

Reference

Study type


Length of follow-up Outcome measures

Source

of

funding

Hamid R, Khastgir J, Arya M et al. Experience of tension-free


N=12 Women with neuropathic bladder dysfunction and stress urinary incontinence

Patient population: mean age 53.3 yrs

Tension-free vaginal tape

Pre-surgery Mean 27.1 mths (range 17 to

Continence (videourodynamically confirmed)

Adverse events

None reported



vaginal tape for the treatment of stress incontinence in females with neuropathic bladders. Spinal Cord. 2003; 41(2):118-121. Ref ID: HAMID2003

(range 41 to 80 yrs)

Crede manoeuvre 3/12, clean intermittent catheterisation 9/12

54 mths)

Effect


Continence 0/12 10/12

Detrusor hyperreflexia - 1/12

Urinary tract infection - 3/12

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Herschorn S, Radomski SB. Fascial slings and bladder neck tapering in the treatment of male neurogenic incontinence. Journal of


N=13 Male patients with neurogenic incontinence

Patient population: Spina bifida n=10, spinal cord injury n=3, mean age 27 yrs (range 17 to 40 yrs)

Urethral sling plus bladder augmentation

2/13 Marlex mesh 11/13 rectus sheath

12/13

Pre-surgery 34.3 mths (range 5.5 to 49 mths)

Continence

Reoperation

Symptomatic urinary infection

Bladder neck narrowing

Wound

None reported



Urology. 1992; 147(4):1073-1075. Ref ID: HERSCHORN1992

underwent bladder neck tapering

infection

Marlex erosions

Bladder stones

Effect



Reoperation - 3/13

Symptomatic urinary infection - 7/13

Bladder neck narrowing - 2/13

Wound infection - 1/13

Marlex erosions - 2/13

Bladder stones - 1/13

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

McGuire EJ, Wang CC, Usitalo H et al. Modified pubovaginal sling in girls with myelodysplasia. Journal of Urology. 1986;


N=8 Female children with myelodysplasia Pubovaginal sling (rectus fascia)

Simultaneous augmentation cystoplasty 1/8

Pre-surgery Not reported

Continence


None reported



135(1):94-96. Ref ID: MCGUIRE1986A

Effect


Continence 0/8 8/8 (dry)


Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Misseri R, Cain MP, Casale AJ et al. Small intestinal submucosa bladder neck slings for incontinence associated with neuropathic bladder. Journal of Urology. 2005; 174(4 Pt 2):1680-1682. Ref ID: MISSERI2005


N=36 Patients treated with small intestinal submucosa (SIS) bladder neck sling procedure for neuropathic urinary incontinence (all with myelodysplasia) with a leak point pressure less than 25 cm H2O and a minimum of 6 mths follow up

Patient population: 21 females and 15 males, mean age 9 yrs (range 3 to 10 yrs)

All had failed on clean intermittent catheterisation and anticholinergic treatment

Small intestinal submucosa (SIS) bladder neck sling

N=27

Bladder neck repair with SIS sling

N=9

All patients underwent Augmentation cystoplasty

Pre surgery Mean 15 mths

Continence (requiring no pads and dry underwear)

Urinary tract infection

Renal complications

None reported

Effect




Continence 0/36 implied Sling alone 19/27 (dry)

Sling plus bladder neck reconstruction 8/9 (dry)

Urinary tract infection - 0/36

Renal complications - 0/36

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Nguyen HT, Bauer SB, Diamond DA et al. Rectus fascial sling for the treatment of neurogenic sphincteric incontinence in boys: is it safe and effective? Journal of Urology. 2001; 166(2):658-661. Ref ID: NGUYEN2001


N=7 Male children with neurogenic sphincteric incontinence

Patient population: myelodysplasia 5/7

Fascial sling (rectus fascia)

Simultaneous continent stoma (N=4)

Pre-surgery 1 to 9 yrs Continence, complications, repeat surgery

None reported

Effect


Continence (completely dry) 0/7 1/7



Occasionally dry 6/7

Complications due to surgery - 1/7 (wound dehiscence)

Repeat sling surgery - 1/7




Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding

Snodgrass W, Barber T, Cost N. Detrusor compliance changes after bladder neck sling without augmentation in children with neurogenic urinary incontinence. Journal of Urology. 2010; 183(6):2361-2366. Ref ID: SNODGRASS2010A


N=26 Patients with neurogenic incontinence

Inclusion criteria: urodynamics within one yr postoperatively and additional testing at least 18 mths postoperatively

Patient population: 21/26 myelomeningocele

15 male and 11 female

360-dregree tight fascial wrap around the bladder neck with appendicovesicostomy but no augmentation

Pre-surgery Mean 39 mths (19 to 94 mths)

continence None reported

Effect


Continence 0/26 implied 16/26 (dry)

Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding

Snodgrass W, Keefover-Hicks A, Prieto J et al. Comparing outcomes of slings

Cohort study

N=41 Children with spina bifida with neurogenic urinary incontinence

Bladder neck sling with augmentation:

Bladder neck sling with augmentation

Bladder neck sling without augmentation

Not reported

Continence

Health-related quality of

None reported



with versus without enterocystoplasty for neurogenic urinary incontinence. Journal of Urology. 2009; 181(6):2709-2714. Ref ID: SNODGRASS2009

male:female 10:8, ambulatory 7/18, mean age at operation 8.6 (range 3.2 to 13.6) yrs

Bladder neck sling without augmentation: male:female 11:12, ambulatory 12/23, ambulatory 12/23, mean age at operation 8.0 (range 4.1 to 14.0) yrs

N=18 N=23 life

Effect

With augmentation Without augmentation

Pre-surgery vs post surgery Post-surgery

Continence

Patient reported

Surgeon reported

0/18 vs 11/18

0/18 vs 13/18

0/23 vs 12/23

0/23 10/23

Health-related quality of life Median score 5 (range 2 to 5) Median score 4 (range 1 to 5) (p<0.019

Reference

Study type

Evidence level


Length of follow-up

Outcome measures

Source

of

funding

Snodgrass W, Barber T. Comparison of bladder outlet procedures without augmentation in children with neurogenic


N=35 360-degree tight bladder neck sling for incontinence due to neurogenic bladder outlet incompetence

Patient population: 32 male 3/35 female, mean age 8.1 yrs

360-degree tight bladder neck sling

Pre-surgery Mean 28 mths (6 to 94 mths)

Continence

None reported



incontinence. Journal of Urology. 2010; 184(4 Suppl):1775-1780. Ref ID: SNODGRASS2010

Effect


Continence 0/35 16/35 (dry)

Hydronephrosis - 0/35

Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding

Walker RD, Erhard M, Starling J. Long-term evaluation of rectus fascial wrap in patients with spina bifida. Journal of Urology. 2000; 164(2):485-486. Ref ID: WALKER2000


N=15 Patients with spina bifida who underwent rectus fascial wrap procedure

7 males and 8 females

Rectus fascial wrap

Augmentation cystoplasty 14/15

Pre-surgery Mean 58 mths (Minimum 36 mths)

Continence

Patient satisfaction

None reported

Effect



Reference

Study type


Length of follow-up

Outcome measures

Source

of

funding


Continence Mean no. of pads used 5.5 1.1

Continence (completely dry) 0/15 implied 5/15

Would you have the operation again? - 14/15

f.9 what is the safety and efficacy of urethral tape and ... · therapy and clean intermittent...

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