Miguel Podesta
Ricardo González- 1Hospital General de Niños Ricardo Gutierrez, Buenos Aires, Argentina
- 2Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- 3Pediatric Surgery and Urology, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
- 4Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
A commentary on
This is a nice study where the authors have tried to demonstrate the comparative efficacy of open and laparoscopic colposuspension in girls with refractory urinary incontinence.
However, this retrospective study is limited by an incompletely defined patient population, since all patients who underwent colposuspension had refractory urinary incontinence with an open bladder neck during filling, hypermobile bladder neck and a flat vesico-urethral angle.
As the authors point out, simultaneous video-pressure-flow cystorethrography is of great value to accurately diagnose the cause of refractory urinary incontinence. However, it is not clear in the paper how many patients had an anatomic malposition of the bladder neck, how many had intrinsic sphincter deficiency and how many had both. This distinction is important since the ideal surgical options for intrinsic sphincter deficiency, are injection of periurethral bulking agents, sling procedures or artificial sphincter placement. Colposuspension only makes sense when the bladder neck is hypermobile, a situation rarely seen in nulliparous adolescent females, but not in congenital bladder neck insufficiency.
Detrusor hyperactivity resulting from an open bladder neck during the filling phase has not been described and we have personally never observed it. A final commentary is that the success rate of a surgical procedure for incontinence treatment should not be based on clinical evidence alone but on objective evaluation test.
Given the rather poor results in the reported series, the reader would be well advised to use colposuspension (open or laparoscopic) in this patient population with caution and only after solid documentation of bladder neck hypermobility.
Author’s Note
This is a commentary on an article included in the Research Topic: “Urinary Incontinence in Children: Controversies Concerning the Bladder Outlet”.
Author Contributions
Both authors contributed equally to the conception and writing of this commentary.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Keywords: urinary incontinence, bladder neck insufficiency, colposuspension, adolescent, laparoscopic surgery, Burch procedure
Citation: Podesta M and González R (2018) Commentary: Open and Laparoscopic Colposuspension in Girls With Refractory Urinary Incontinence. Front. Pediatr. 6:67. doi: 10.3389/fped.2018.00067
Received: 22 December 2017; Accepted: 08 March 2018;
Published: 27 March 2018
Edited by:
Marco Castagnetti, Azienda Ospedaliera di Padova, ItalyReviewed by:
Marc Cendron, Harvard University, United StatesRoberto Iglesias Lopes, Hospital for Sick Children, Canada
Copyright: © 2018 Podesta and González. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ricardo González, cmljYXJkb19nb256YWxlejMzMTU0JiN4MDAwNDA7eWFob28uY29t