OBJECTIVES: To evaluate the long-term outcome of the Pippi Salle procedure for severe intrinsic sphincter deficiency (ISD).
MATERIALS AND METHODS: Between March 2003 and August 2013, we performed the Pippi Salle procedure on 12 patients with severe ISD (6 male, 6 female). The median age was 15 years (range 6-45). The mean follow-up period was 75 months (range 17-142). Nine patients (6 male, 3 female) had neurogenic ISD: spina bifida (n=8) and spinal cord injury (n=1). Three female patients had anatomical ISD: pseudo-ureterocele (n=1) and idiopathic bladder hypoplasia (n=2). Of all patients, 4 had previous bladder neck surgery: endoscopic injection of collagen (n=3), fascial sling (n=2), and tension-free vaginal tape surgery (n=1). The Pippi Salle procedure was performed alone (n=2) or in combination with bladder augmentation (n=4) or catheterizable abdominal stoma (n=1) or both (n=5).
RESULTS: Complete dryness was achieved in 7/12 patients (58%). Of 9 patients with neurogenic ISD, 7 achieved complete dryness (78%). Eight patients experienced complications, including continued urinary incontinence (n=5), catheterization difficulty through the urethra (n=3), and urinary calculi (n=1). These 8 patients were successfully treated with additional endoscopic interventions: injection of collagen (n=4) or Dx/HA (n=1), transurethral incision of urethral kink (n=3), and vesicolithotripsy (n=1). After these simple interventions, complete dryness was achieved in all 12 patients (100%).
CONCLUSIONS: Although we experienced some minor complications in the short term, most were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.
Written by:
Nakamura S, Hyuga T, Kawai S, Nakai H. Are you the author?
Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan.
Reference: J Urol. 2015 Jun 5. pii: S0022-5347(15)04117-8.
doi: 10.1016/j.juro.2015.05.095
PubMed Abstract
PMID: 26055826