The following is a summary of “Bladder Exstrophy-Epispadias Complex: The Effect of Urotherapy on Incontinence,” published in the May 2024 issue of Pediatrics by Geen et al.
Urinary continence remains a significant challenge for children born with the bladder exstrophy-epispadias complex (BEEC) despite extensive surgical interventions aimed at achieving this goal. The repetitive hospitalizations and surgeries associated with these treatments can adversely affect the quality of life. Therefore, there is a critical need to explore conservative approaches earlier in managing incontinence among patients with BEEC. This study evaluates the efficacy of an intensive urotherapy program implemented after reconstructive surgery for BEEC to improve continence outcomes.
A retrospective chart review was conducted, encompassing children enrolled in an intensive urotherapy program due to persistent incontinence following reconstructive surgery for BEEC. This program involved a ten-day inpatient training regimen rooted in cognitive behavioral therapy, complemented by rigorous follow-up under the supervision of experienced urotherapists. The primary outcome measure was the achievement of continence, classified as complete continence (100% dry) or significant improvement (50-99% reduction in wet days per week) post-treatment.
Data from 33 patients with an average age of 10.6 years were analyzed. Of these, 61% (20/33) exhibited complete continence or marked improvement in incontinence following intensive urotherapy. Notably, children diagnosed with classic bladder exstrophy were more likely to achieve favorable outcomes (81%; 13/16) compared to those with epispadias (38%; 6/16). The sole patient with cloacal exstrophy completed treatment with improved continence outcomes. Among patients experiencing persistent incontinence, 75% (12/16) reported that their symptoms were socially acceptable after the follow-up period.
The findings underscore the efficacy of intensive urotherapy in enhancing continence outcomes for most patients with BEEC. Moreover, the inpatient training program positively impacted the acceptance of persistent incontinence, highlighting the importance of personalized care and clear guidance provided by urotherapists in achieving successful treatment outcomes. Given the potential limitations and uncertainties associated with repeated surgical interventions, the study supports prioritizing conservative treatment options in managing BEEC-related incontinence.
In this study, 37% (12/33) of patients enrolled in the intensive urotherapy program achieved complete continence following reconstructive surgery for persistent incontinence related to BEEC, while 63% (21/33) experienced varying degrees of improvement. Significantly, 75% of patients who did not achieve complete continence described their remaining incontinence as socially manageable. These findings strongly advocate for counseling patients with BEEC on the potential benefits of conservative treatments before considering additional surgical interventions.
Source: sciencedirect.com/science/article/pii/S1477513124002717
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