Repeated catheterisation and drugs with a pharmacodynamic action are not always able to ensure perfect continence in children with meningomyeloceles. To treat uncontrollable incontinence, the authors propose an aponeurotic suspension of the bladder neck as described by Goebbel-Stoeckel in order to increase the peripheral resistance. At the same time, sufficient bladder compliance can also be obtained either by means of pharmacodynamic treatment or by enlargement enterocystoplasty. The aim is to obtain catheterisation every 4 to 6 hours without any incontinence. Young girls constitute the ideal indication for this programme as catheterisation is safe and easily accepted. Ten girls underwent Goebbel-Stoeckel operation, associated with sigmoido-cystoplasty in 6 cases. Eight of these girls are now perfectly continent with a normal social life, including one case with a follow-up of 12 years and a pregnancy. The authors stress the need, in cases of enterocystoplasty, to resect almost all of the pathological detrusor and to use the caecum rather than the hypertonic sigmoid.
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[Stress urinary incontinence in women caused by severe sphincter hypotonia. Goebbel-Stoeckel intervention as alternative to artificial sphincter. Apropos of 26 cases treated between January 1985 and January 1994].
J Urol (Paris)
December 1998
Clinique Urologique, Hôpital Cochin, Paris.
Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation.
View Article and Find Full Text PDFFrom 1985 to 1990, 119 female patients underwent a cure for urinary incontinence on exertion according to a technique that varied according to the period and to the data of the literature. From 1985 to 1988, 42 patients were operated with the Goebbel-Stoeckel technique; from 1986 to 1988, 32 patients were operated with Stamey's procedure, and 47 patients with Gittes' procedure from 1988 to 1990. These three groups of patients with comparable ages, previous history and degree of urinary incontinence on exertion were analyzed by the same surgeon for functional results and morbidity, both in the immediate three months after surgery and in July, 1991, with an average distance in time of 29 months.
View Article and Find Full Text PDFRepeated catheterisation and drugs with a pharmacodynamic action are not always able to ensure perfect continence in children with meningomyeloceles. To treat uncontrollable incontinence, the authors propose an aponeurotic suspension of the bladder neck as described by Goebbel-Stoeckel in order to increase the peripheral resistance. At the same time, sufficient bladder compliance can also be obtained either by means of pharmacodynamic treatment or by enlargement enterocystoplasty.
View Article and Find Full Text PDFUrine incontinence of sphincteric origin in the little girl can have several origins: epispadias, hypospadias, bilateral single ectopic ureters, isolated sphincteric agenesis, iatrogenic lesion of the sphincter, complications of ureterocele. Creation of a new urethra alone, whatever the technique used, seldom restores continence. In addition, the proximal urethra is supported by means of an aponeurotic flap, the results improve considerably: in this series, 6 good results out of 7.
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