[Selected secondary reconstructive procedures for improvement of urinary incontinence in bladder exstrophy and neurogenic bladder dysfunction in childhood].

Partial or complete urinary and stool incontinence due to malformation of the genito-urinary tract and the pelvic floor despite of several operative reconstructions is the most important handicap in the patients life. Often this problems seems to be unsoluble. In recent time we secondarily reconstructed 7 patients suffering from urinary incontinence: 1 girl and 4 boys with bladder ekstrophy; 1 boy with a complex anomaly with menigomyelocele, sinus urogenitalis, single kidney with vesicorenal reflux and neurogene bladder; 1 boy with complex anomaly of the pelvis and the lower limbs with duplication of the bladder with an ekstrophic left part. All patients underwent multiple operative trials of reconstruction. Until that time all patients suffered from complete urinary incontinence. At the age of 5 to 14 years we performed the secondary reconstruction: bladder-neck-plasty and ileumaugmentation (3 patients), closure of the bladder-neck, ileumaugmentation and a continent appendicostoma (Mitrofanoff's method)), Mainz-I-pouch and a continent appendicostoma respectively ileostoma (Monti's technique) (2 patients), Mainz-II-pouch. With a normal bladder-capacity all patients are completely continent postoperatively; one patient has regained partial continence. The emptying of the bladder is carried out by clean intermittent catheterism (CIC) with the exception of the one patient with the Mainz-II-pouch. Even in patients with complex anomalies of the pelvic floor and the genitourinary tract complete urinary continence is possible in consequence of recently developed operative techniques. Because of a high rate of complications we reject the primary use of artificial sphincter systems for children.