Results of the rectus fascial sling and wrap procedures for the treatment of neurogenic sphincteric incontinence

PURPOSE: We assessed the early results of the rectus fascial sling and modified rectus fascial wrap for treating neurogenic sphincteric incontinence in a pediatric population. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients who underwent a rectus fascial sling or wrap procedure for neurogenic incontinence at our institution. Most recent status was confirmed by telephone interview as successful-complete day and night dryness, partially successful-occasional daytime wetting and/or nocturnal enuresis and failed-frequent daytime incontinence. Results were analyzed with regard to patient sex, associated bladder augmentation and previous or subsequent anti-incontinence surgery. RESULTS: A total of 27 patients underwent 10 sling and 18 wrap procedures. Five patients in each group were dry after 1 to 4.5 years of followup. Six of the 7 boys were wet and 1 was partially dry postoperatively, while 10 of the 20 girls became dry (p = 0.026 Fisher's exact test), resulting in an overall 36% success rate. In failed cases continence was achieved after periurethral collagen injection and artificial urinary sphincter placement in 0 of 5 and 5 of 6, respectively. CONCLUSIONS: Total continence was achieved even after a brief followup in a minority of patients in whom rectus fascia was used to correct neurogenic incontinence. However, our early data suggest that cases in which these procedures fail may be salvaged by artificial urinary sphincter implantation but not by periurethral collagen injection.