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Management of urinary incontinence in neurogenic bladder.

The treatment of children with urinary incontinence caused by a neurogenic bladder presents a challenge to the paediatric urologist. Between 1965 and 1989, 527 patients with neurogenic bladder were treated and followed-up in the Department of Paediatric Urology of Debrousse Hospital. Of these, 46 were submitted to continent cystostomy, 39 to urinary artificial sphincter and 177 to clean intermittent catheterization (CIC). This last treatment is of paramount importance in girls and can be associated with complementary procedures if cervico-urethral resistance and/or bladder compliance are poor. Urethral lengthening (Kropp's procedure) in combination with CIC represents a major means of providing dryness in girls. Our technique of urethral lengthening is detailed and the place of CIC among other incontinence treatment is discussed.