Management of Urinary Incontinence in Girls with Congenital Pouch Colon

Abstract Purpose This study describes the management of urinary incontinence (UI) in 8 girls with congenital pouch colon (CPC) associated with anorectal malformation (ARM). Methods From 2013 to 2015, 6 girls with CPC and UI underwent bladder neck reconstruction (BNR). Four girls had complete UI (CUI) and 2 girls partial UI (PUI). From 2019 to 2023, 4 girls, including 2 with failed BNR, underwent bladder neck closure (BNC) and augmentation cystoplasty (AC) with a continent stoma. Subtypes of CPC were Type I (n=1); Type II CPC (n=5); and Type III CPC (n=2). All girls had a double vagina; short, wide urethra; and reduced bladder capacity with an open, incompetent bladder neck (BNI). During BNR, a neourethra was constructed from a 1.5-2 cm wide and 1.5-3 cm long trigonal strip. During BNC, AC was performed using a 20-cm ileal segment (n=3) and by a colonic pouch segment, preserved during earlier colorraphy (n=1). Continent stoma included a Monti’s channel (n=3) and appendicovesicostomy (n=1). Results BNR produced moderate improvement of UI (n=2) while UI was still very severe (n=4). During BNC, intraoperative complications included iatrogenic vaginal tears (n=4). Early complications included partial dehiscence of the ileocystoplasty (n=1), partial adhesive small bowel obstruction (n=1), and difficulty in stomal catheterization with prolonged drainage from the pelvic drain (n=1). Late complications included unilateral grade II vesico-ureteric reflux (n=2), and vesico-vaginal fistula (VVF) (n=2) needing trans-vaginal closure in one girl. Urinary stones (n=2) with stomal leakage of urine in one girl needed open cystolithotomy twice (n=1), and endoscopic lithotripsy (n=1). At follow-up, all patients have high overall satisfaction with the procedure and their continence status. Conclusions BNC with AC and a catheterizable stoma satisfactorily achieves continence in girls with CPC and UI, vastly improving quality of life. If lower urinary tract (LUT) anatomy is favorable, BNR with/ without AC can be the initial surgical procedure. BNC should be the primary procedure in girls with unfavorable LUT anatomy and for failed BNR. LEVEL OF EVIDENCE: IV