Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector100010.17816/psaic1000Original Study ArticlesОригинальные исследованияResearch ArticleEffectiveness of urethral endosphincteroplasty in children with urinary incontinence, myelodysplasia, and epispadiasЭффективность уретральной эндосфинктеропластики у детей с недержанием мочи при миелодисплазии и эписпадииhttps://orcid.org/0000-0002-0788-93545568-8660DemidovAlexandr A.ДемидовАлександр Александрович
Russian Federation

Can. Sci. (Med.), senior research associate

канд. мед. наук, ст. научн. сотр.

demidoval10@list.ruhttps://orcid.org/0000-0003-2606-12184260-9453MlynchikElena V.МлынчикЕлена Вячеславовна
Russian Federation

Can. Sci. (Med.); urologist-andrologist for children

канд. мед. наук, врач – уролог-андролог детский

mlynchik@yanex.ruVeltishchev Research Clinical Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Medical UniversityНаучно-исследовательский клинический институт педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева, Российский национальный исследовательский медицинский университет им. Н.И. ПироговаSperansky Children’s HospitalДетская городская клиническая больница № 9 им. Г.Н. Сперанского22092022021120221233373500909202105092022Copyright ©; 2022, Eco-VectorCopyright ©; 2022, Эко-Вектор2022Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1000

BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug.

AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer.

MATERIALS AND METHODS: The study analyzed 38 patients (5–17 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a “stable” polyacrylamide mesh polymer with silver ions were performed.

RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children.

DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system.

CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.

Актуальность. Периуретральные инъекции различных материалов в лечении пациентов со стрессовым недержанием мочи известны с 1938 г. В литературных источниках нам не удалось встретить сообщений об эндохирургической коррекции недержания мочи при миелодисплазии и эписпадии у детей как основного метода лечения, патогенетически обоснованного алгоритма обследования для прогнозирования результата инъекции с учетом эндоскопической техники и объема введенного препарата.

Цель — оценить отдаленные результаты коррекции стрессового недержания мочи у детей с миелодисплазией и эписпадией после эндоимплантации стабильного синтетического объемообразующего полимера.

Материалы и методы. Объектом исследования были 38 пациентов (5–17 лет) с недержанием мочи с миелодисплазией и эписпадией: мальчиков с эписпадией — 9, девочек — 3; с миелодисплазией мальчиков — 10, девочек — 16. С диагностической целью использовали клинические, инструментальные (экскреторную урографию, цистографию, цистоскопию, урофлоуметрию, электрофизиологические и уродинамические) методы обследования. Для коррекции инконтиненции выполняли внутри- и парауретральную эндоинъекцию «стабильного» полиакриламидного сетчатого полимера с ионами серебра.

Результаты. По данным литературы, эффективность внутриуретрального введения стабильных имплантов при недержании мочи в катамнезе до 12 мес. достигала 50 %, при более длительном наблюдении положительные результаты не превышали 40 % наблюдений. В представленной работе полное удержание мочи достигнуто у 25 детей (66 %). Удовлетворительный результат (инконтиненция днем до 40 мл) зарегистрирован в 8 наблюдениях (21 %). Неудовлетворительный результат — у 5 детей (13 %).

Обсуждение. Показания к эндосфинктеропластике у детей со стрессовой инконтиненцией при миелодисплазии и эписпадии стабильным имплантом должны определяться с учетом уродинамики, кровообращения, иннервации и функциональных (уретральная профилометрия) параметров в системе детрузор – сфинктеры – тазовое дно.

Заключение. Операции данного типа у пациентов с миелодисплазией и эписпадией с изолированной недостаточностью уретральных сфинктеров могут проводиться как самостоятельный метод, а их эффективность достигать 70 %.

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