Management of sphincter insufficiency in patients with neurogenic bladder and bladder augmentation

PURPOSE: To investigate the need and efficacy of treatment of bladder neck procedures in patients with neurogenic bladder and augmentation. METHODS: The hospital database was reviewed for patients undergoing enterocystoplasty because of neurogenic bladder during 1990–2019. Diagnoses of patients as well as frequency, type, and efficacy of treatment of sphincter insufficiency were evaluated. RESULTS: Thirty-seven of 87 patients (43%) underwent surgery because of sphincter insufficiency. The median age at bladder augmentation was 11.9 years (IQR 8.5–14.8), and at the last control, 21.8 years (IQR 18.9–31.1). Bladder neck injections (BNI) were performed for 28 patients, fascial sling operation for 14 patients, and bladder neck closure (BNC) was done for five females. Full continence was achieved in 10/28 (36%) patients with one or repeat BNIs and 9/14 (64%) with sling operation. The outcome of BNIs and sling operations was similar in both sexes. All five female patients with BNC became continent. At the end of follow-up, 64 (74%) patients were dry, 19 (22%) had occasional incontinence episodes, and 4 (5%) had daily incontinence episodes necessitating pads. CONCLUSIONS: Treatment of sphincter insufficiency is challenging in patients with bladder augmentation and neurogenic disease. Only 74% of our patients became fully continent despite treatments for sphincter insufficiency.