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paediactric stress incontinence
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paediactric stress incontinence

Dear Sir

Our son, who is now 3yrs old was born with Spina Bifida.We have just been told by his urologist that,(after doing various tests)he has the worst type of bladder and despite being prescribed Oxybutonin/Ditropan, his bladder is still not holding all it should. We have been told that his sphincter muscle is paralised as a result of the SB.

We can either have an injection to thicken the bladder?, have some kind of reconstruction in the neck to give the sphincter more resistence or have the bladder sealed off completely.

The consultant told us that in boys, there is only a 30-35% success with any of this. The injection can also cause high blood pressure, but can be administered at any age, but he was not sure of the frequency and effect it would have on our son. Sealing off the bladder he said would be a very last resort.

My husband and I were wondering what kind of treatments there are in the pipeline that you may be able to advise us about as we know medical science is always making advances?

Our urologist describes our son's condition as stress incontinence.

Our little boy is only 3 and we are trying to find out what we can for him as he is doubly incontinent and the SB has affected everything below the waist including walking, sensation and movement and we feel he will have enough to cope with later on.

At the moment he attends nursery in nappies and is intermittently catheterised every 4 hours. A specially trained carer looks after his toileting needs whilst he is there (prior to this I was doing it myself)

We have also read in the daily newspapers about a drug called SOLIFENACIN SUCCINATE and wondered what you could tell us about this please?

Thank you for your time and we look forward to hearing from you soon.

Siobhan

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Here are some surigcal treatment options for urological problems in spina bifida.

Vesicostomy
Vesicostomy is indicated in the presence of persistent hydronephrosis and recurrent urinary tract infection when the bladder continually fails to empty. This simple procedure which involves making a stoma from the bladder to the skin surface to allow drainage, has a low revision rate and allows normal growth and maturation. Vesicostomies are often performed as temporary procedures in children.

Urinary diversion
Urinary diversion can be used when augmentation procedures fail to work for many physical, personal and social reasons. Procedures include illeal and colon conduits and cutaneous ureterostomy.

Augmentation cystoplasty
Augmentation cystoplasty involves surgically configuring a segment of bowel to augment the bladder and correct vesicoureteric reflux. When deciding upon an augmentation cystoplasty, issues to consider include which part of the bowel to use, eg. illeum, stomach, sigmoid colon or other section.

Transurethral injection
Transurethral injection therapy is used to treat intrinsic sphincter deficiency and involves the submucosal injection of a biocompatible substance such as collagen or silicon. The efficacy of treatment depends largely upon selecting patients with suitable urodynamic patterns. The advantage of submucosal injection is the low morbidity, but its main disadvantage is the lack of long term data on most of the substances.

Artificial urinary sphincters
Artificial urinary sphincters are implanted silicon devices that close the urethra. The artificial sphincter may be placed at the bladder neck or bulbar urethra. The artificial sphincter is regarded as the main treatment option for male patients with intrinsic sphincter deficiency. Again, post-operative monitoring is essential to ensure that urinary tract complications due to the elevated bladder pressure associated with an artificial sphincter are prevented.

You may want to discuss these options with your urologist.

Solifenacin is an investigational muscarinic antagonist currently under review by the U.S. Food and Drug Administration and not available for commercial use.  Studies have shown some promise in the treatment for overactive bladder.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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