Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures

Konrad Szymanski, R. C. Rink, Benjamin Whittam, J. D. Ring, R. Misseri, Martin Kaefer, M. P. Cain

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: The Kropp and Salle procedures have shown good short-term outcomes for managing neuropathic urinary incontinence. However, few studies have assessed their long-term results. Objective: This study aimed to evaluate the long-term outcomes of Kropp and Salle procedures, including: dryness, secondary interventions for incontinence or complications, upper urinary tract changes, and use of urethral catheterizations. Study design: Consecutive patients undergoing Kropp and Salle procedures at the present institution (1983-2012) were retrospectively reviewed. Patients with <1-year follow-up or prior bladder neck (BN) continence procedures were excluded. Data were collected on postoperative dryness per urethra at 4-hourly and 3-hourly intervals, secondary interventions, lab tests, and imaging. Non-parametric tests were used for statistical analysis. Results: Thirty-eight patients had Kropp (K: 30 boys) and 12 had Salle procedures (S: 8 boys). Patients underwent surgery at similar median ages (K: 7.4 vs S: 8.7 years old, . P = 0.51) and had similar median follow-up (6.9 vs 10.3 years, . P = 0.10). Most patients had myelomeningocele, a prior/concomitant bladder augmentation (K: 73.7%, S: 58.3%) and catheterizable channel (K: 81.6%, S: 50.0%). Differences in all outcomes between Kropp and Salle procedures were statistically non-significant. The majority of patients did not have additional BN procedures for dryness (K: 84.2%, S: 66.7%). Of this group, K: 81.3% and S: 75.0% were dry for ≥4 h, K: 93.8% and S: 87.5% were dry for ≥3 h between catheterizations (Table). Of the minority of patients who underwent additional BN procedures for dryness (K: 15.8%, S: 33.3%), most achieved dryness for ≥4 h (K: 66.7%, S: 100%) and ≥3 h (100% for both). Among patients without an initial catheterizable channel, 57.1% had one subsequently created after a Kropp procedure, and 33.3% after a Salle. Among patients without bladder augmentation, approximately half underwent delayed augmentation (K: 50.0%, S: 40.0%). Ultimately, most patients required a secondary intervention under anesthesia for incontinence or complications (K: 79.0%, S: 66.7%). Few patients developed worsening hydronephrosis, vesicoureteral reflux or renal function (K: 2.6%, S: 0.0%). At the end of follow-up, few patients catheterized per urethra (K: 10.5%, S: 33.3%). Discussion: This was a retrospective study without urodynamic data. Originating from a tertiary center, the results may not apply to other clinical settings. Conclusions: At the present institution the Kropp and Salle procedures attained similar dryness in 75-81% at 4-hourly intervals and 88-94% at 3-hourly intervals without additional BN procedures. Few patients required subsequent BN procedures to achieve dryness. However, the overall need for secondary procedures during long-term follow-up was high for both procedures.Summary tableDryness after urethral lengthening procedures.Summary tableDrynessKroppSalle P-valueSecondary bladder neck continence surgeryNo (n = 32)Yes (n = 6)No (n = 8)Yes (n = 4)4 h or longer81.3%66.7%75.0%100.0%0.653 h or longer93.8%100.0%87.5%100.0%0.50Overnight90.6%100.0%87.5%50.0%0.99 . .

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StateAccepted/In press - Apr 22 2016

Fingerprint

Urinary Bladder
Urethra
Urinary Catheterization
Meningomyelocele
Vesico-Ureteral Reflux
Hydronephrosis
Urodynamics
Urinary Incontinence
Urinary Tract
Catheterization
Anesthesia
Retrospective Studies
Kidney

Keywords

  • Child
  • Surgical flaps
  • Urethra
  • Urinary bladder
  • Urinary incontinence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures. / Szymanski, Konrad; Rink, R. C.; Whittam, Benjamin; Ring, J. D.; Misseri, R.; Kaefer, Martin; Cain, M. P.

In: Journal of Pediatric Urology, 22.04.2016.

Research output: Contribution to journalArticle

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title = "Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures",
abstract = "Introduction: The Kropp and Salle procedures have shown good short-term outcomes for managing neuropathic urinary incontinence. However, few studies have assessed their long-term results. Objective: This study aimed to evaluate the long-term outcomes of Kropp and Salle procedures, including: dryness, secondary interventions for incontinence or complications, upper urinary tract changes, and use of urethral catheterizations. Study design: Consecutive patients undergoing Kropp and Salle procedures at the present institution (1983-2012) were retrospectively reviewed. Patients with <1-year follow-up or prior bladder neck (BN) continence procedures were excluded. Data were collected on postoperative dryness per urethra at 4-hourly and 3-hourly intervals, secondary interventions, lab tests, and imaging. Non-parametric tests were used for statistical analysis. Results: Thirty-eight patients had Kropp (K: 30 boys) and 12 had Salle procedures (S: 8 boys). Patients underwent surgery at similar median ages (K: 7.4 vs S: 8.7 years old, . P = 0.51) and had similar median follow-up (6.9 vs 10.3 years, . P = 0.10). Most patients had myelomeningocele, a prior/concomitant bladder augmentation (K: 73.7{\%}, S: 58.3{\%}) and catheterizable channel (K: 81.6{\%}, S: 50.0{\%}). Differences in all outcomes between Kropp and Salle procedures were statistically non-significant. The majority of patients did not have additional BN procedures for dryness (K: 84.2{\%}, S: 66.7{\%}). Of this group, K: 81.3{\%} and S: 75.0{\%} were dry for ≥4 h, K: 93.8{\%} and S: 87.5{\%} were dry for ≥3 h between catheterizations (Table). Of the minority of patients who underwent additional BN procedures for dryness (K: 15.8{\%}, S: 33.3{\%}), most achieved dryness for ≥4 h (K: 66.7{\%}, S: 100{\%}) and ≥3 h (100{\%} for both). Among patients without an initial catheterizable channel, 57.1{\%} had one subsequently created after a Kropp procedure, and 33.3{\%} after a Salle. Among patients without bladder augmentation, approximately half underwent delayed augmentation (K: 50.0{\%}, S: 40.0{\%}). Ultimately, most patients required a secondary intervention under anesthesia for incontinence or complications (K: 79.0{\%}, S: 66.7{\%}). Few patients developed worsening hydronephrosis, vesicoureteral reflux or renal function (K: 2.6{\%}, S: 0.0{\%}). At the end of follow-up, few patients catheterized per urethra (K: 10.5{\%}, S: 33.3{\%}). Discussion: This was a retrospective study without urodynamic data. Originating from a tertiary center, the results may not apply to other clinical settings. Conclusions: At the present institution the Kropp and Salle procedures attained similar dryness in 75-81{\%} at 4-hourly intervals and 88-94{\%} at 3-hourly intervals without additional BN procedures. Few patients required subsequent BN procedures to achieve dryness. However, the overall need for secondary procedures during long-term follow-up was high for both procedures.Summary tableDryness after urethral lengthening procedures.Summary tableDrynessKroppSalle P-valueSecondary bladder neck continence surgeryNo (n = 32)Yes (n = 6)No (n = 8)Yes (n = 4)4 h or longer81.3{\%}66.7{\%}75.0{\%}100.0{\%}0.653 h or longer93.8{\%}100.0{\%}87.5{\%}100.0{\%}0.50Overnight90.6{\%}100.0{\%}87.5{\%}50.0{\%}0.99 . .",
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T1 - Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures

AU - Szymanski, Konrad

AU - Rink, R. C.

AU - Whittam, Benjamin

AU - Ring, J. D.

AU - Misseri, R.

AU - Kaefer, Martin

AU - Cain, M. P.

PY - 2016/4/22

Y1 - 2016/4/22

N2 - Introduction: The Kropp and Salle procedures have shown good short-term outcomes for managing neuropathic urinary incontinence. However, few studies have assessed their long-term results. Objective: This study aimed to evaluate the long-term outcomes of Kropp and Salle procedures, including: dryness, secondary interventions for incontinence or complications, upper urinary tract changes, and use of urethral catheterizations. Study design: Consecutive patients undergoing Kropp and Salle procedures at the present institution (1983-2012) were retrospectively reviewed. Patients with <1-year follow-up or prior bladder neck (BN) continence procedures were excluded. Data were collected on postoperative dryness per urethra at 4-hourly and 3-hourly intervals, secondary interventions, lab tests, and imaging. Non-parametric tests were used for statistical analysis. Results: Thirty-eight patients had Kropp (K: 30 boys) and 12 had Salle procedures (S: 8 boys). Patients underwent surgery at similar median ages (K: 7.4 vs S: 8.7 years old, . P = 0.51) and had similar median follow-up (6.9 vs 10.3 years, . P = 0.10). Most patients had myelomeningocele, a prior/concomitant bladder augmentation (K: 73.7%, S: 58.3%) and catheterizable channel (K: 81.6%, S: 50.0%). Differences in all outcomes between Kropp and Salle procedures were statistically non-significant. The majority of patients did not have additional BN procedures for dryness (K: 84.2%, S: 66.7%). Of this group, K: 81.3% and S: 75.0% were dry for ≥4 h, K: 93.8% and S: 87.5% were dry for ≥3 h between catheterizations (Table). Of the minority of patients who underwent additional BN procedures for dryness (K: 15.8%, S: 33.3%), most achieved dryness for ≥4 h (K: 66.7%, S: 100%) and ≥3 h (100% for both). Among patients without an initial catheterizable channel, 57.1% had one subsequently created after a Kropp procedure, and 33.3% after a Salle. Among patients without bladder augmentation, approximately half underwent delayed augmentation (K: 50.0%, S: 40.0%). Ultimately, most patients required a secondary intervention under anesthesia for incontinence or complications (K: 79.0%, S: 66.7%). Few patients developed worsening hydronephrosis, vesicoureteral reflux or renal function (K: 2.6%, S: 0.0%). At the end of follow-up, few patients catheterized per urethra (K: 10.5%, S: 33.3%). Discussion: This was a retrospective study without urodynamic data. Originating from a tertiary center, the results may not apply to other clinical settings. Conclusions: At the present institution the Kropp and Salle procedures attained similar dryness in 75-81% at 4-hourly intervals and 88-94% at 3-hourly intervals without additional BN procedures. Few patients required subsequent BN procedures to achieve dryness. However, the overall need for secondary procedures during long-term follow-up was high for both procedures.Summary tableDryness after urethral lengthening procedures.Summary tableDrynessKroppSalle P-valueSecondary bladder neck continence surgeryNo (n = 32)Yes (n = 6)No (n = 8)Yes (n = 4)4 h or longer81.3%66.7%75.0%100.0%0.653 h or longer93.8%100.0%87.5%100.0%0.50Overnight90.6%100.0%87.5%50.0%0.99 . .

AB - Introduction: The Kropp and Salle procedures have shown good short-term outcomes for managing neuropathic urinary incontinence. However, few studies have assessed their long-term results. Objective: This study aimed to evaluate the long-term outcomes of Kropp and Salle procedures, including: dryness, secondary interventions for incontinence or complications, upper urinary tract changes, and use of urethral catheterizations. Study design: Consecutive patients undergoing Kropp and Salle procedures at the present institution (1983-2012) were retrospectively reviewed. Patients with <1-year follow-up or prior bladder neck (BN) continence procedures were excluded. Data were collected on postoperative dryness per urethra at 4-hourly and 3-hourly intervals, secondary interventions, lab tests, and imaging. Non-parametric tests were used for statistical analysis. Results: Thirty-eight patients had Kropp (K: 30 boys) and 12 had Salle procedures (S: 8 boys). Patients underwent surgery at similar median ages (K: 7.4 vs S: 8.7 years old, . P = 0.51) and had similar median follow-up (6.9 vs 10.3 years, . P = 0.10). Most patients had myelomeningocele, a prior/concomitant bladder augmentation (K: 73.7%, S: 58.3%) and catheterizable channel (K: 81.6%, S: 50.0%). Differences in all outcomes between Kropp and Salle procedures were statistically non-significant. The majority of patients did not have additional BN procedures for dryness (K: 84.2%, S: 66.7%). Of this group, K: 81.3% and S: 75.0% were dry for ≥4 h, K: 93.8% and S: 87.5% were dry for ≥3 h between catheterizations (Table). Of the minority of patients who underwent additional BN procedures for dryness (K: 15.8%, S: 33.3%), most achieved dryness for ≥4 h (K: 66.7%, S: 100%) and ≥3 h (100% for both). Among patients without an initial catheterizable channel, 57.1% had one subsequently created after a Kropp procedure, and 33.3% after a Salle. Among patients without bladder augmentation, approximately half underwent delayed augmentation (K: 50.0%, S: 40.0%). Ultimately, most patients required a secondary intervention under anesthesia for incontinence or complications (K: 79.0%, S: 66.7%). Few patients developed worsening hydronephrosis, vesicoureteral reflux or renal function (K: 2.6%, S: 0.0%). At the end of follow-up, few patients catheterized per urethra (K: 10.5%, S: 33.3%). Discussion: This was a retrospective study without urodynamic data. Originating from a tertiary center, the results may not apply to other clinical settings. Conclusions: At the present institution the Kropp and Salle procedures attained similar dryness in 75-81% at 4-hourly intervals and 88-94% at 3-hourly intervals without additional BN procedures. Few patients required subsequent BN procedures to achieve dryness. However, the overall need for secondary procedures during long-term follow-up was high for both procedures.Summary tableDryness after urethral lengthening procedures.Summary tableDrynessKroppSalle P-valueSecondary bladder neck continence surgeryNo (n = 32)Yes (n = 6)No (n = 8)Yes (n = 4)4 h or longer81.3%66.7%75.0%100.0%0.653 h or longer93.8%100.0%87.5%100.0%0.50Overnight90.6%100.0%87.5%50.0%0.99 . .

KW - Child

KW - Surgical flaps

KW - Urethra

KW - Urinary bladder

KW - Urinary incontinence

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