Further experience of free muscle transplantation in children with urinary incontinence.

Sixteen patients, 10 boys and 6 girls with severe urinary incontinence due to congenital malformations, were treated by free autogenous muscle transplantation. The mean follow-up period was 2.3 years. In 10 patients the results were good, implying increase in functional bladder capacity and abandoning of napkins during the day. Two patients were improved and 4 were failures. The earliest signs of improvement appeared 2 to 6 months after surgery. Most patients showed further improvement for at least 2 years post-operatively. Cine studies of micturition clearly showed activity of the transplant, most patients with good results being able to interrupt completely the urinary stream at will. Seven patients exhibited normal urinary flow post-operatively. In 5 patients the maximal urinary flow was around the lower normal limit, in two because of detrusor-sphincter dyssynergia. In boys, erection was unimpaired post-operatively. The prognosis seems to be better in girls than in boys, especially when comparing cases of epispadias. Patients with no sign of improvement during the first 6 months post-operatively had a poor prognosis. A relatively large bladder capacity before operation is advantageous, but not a prerequisite for continence, as bladder capacity can develop after transplantation. The ideal age for transplantation is 5 to 6 years.