Advances in Clinical and Experimental Medicine
2014, vol. 23, nr 2, March-April, p. 283–287
Publication type: original article
An Evaluation of the Effectiveness of External Urethral Meatus Incision in Girls with an Anterior Deflected Urinary Stream and Symptoms of Detrusor Overactivity
1 Department and Clinic of Pediatric Surgery and Urology, Wroclaw Medical University, Poland
2 Department of Pathomorphology, Wroclaw Medical University, Poland
3 Department of Urology and Oncology, Wroclaw Medical University, Poland
4 Department of Palliative Care Nursing, Wroclaw Medical University, Poland
5 Department and Clinic of Pediatric Nephrology, Wroclaw Medical University, Poland
Background. Urethral stenosis or abnormalities in the external urethral meatus in girls may lead to serious functional bladder outlet obstruction and recurrent urinary tract infections.
Objectives. The aim of the study was to analyze the efficacy of meatotomy in girls with an anterior deflected urinary stream (AdUS) and symptoms of detrusor overactivity.
Material and Methods. A group of 67 girls between the ages of 5 and 16 (mean age: 8.6 years) with symptoms of detrusor overactivity participated in the study. The girls were treated with oxybutinin in the years 2010−2011. The group included 37 girls with AdUS (the AdUS group) while the remaining 30 girls (the OXY group) were found to have a normal urinary stream. In the AdUS group an external urethral meatus incision was performed. The follow-up period was three months. The presence of urinary tract infections (UTI) as well as nocturnal bedwetting and daytime incontinence were analyzed before and after treatment.
Results. After three months, in the AdUS group no UTI was found in 12 children (32%) (p < 0.05), including 11 patients with prior febrile UTI (p < 0.05). Recovery from daytime urinary incontinence was observed in 20 girls (54%) and recovery from nocturnal bedwetting in 8 girls (22%). In the OXY group no infections were found in three girls (10%); recovery from daytime urinary incontinence was noted in 21 girls (70%) and from nocturnal bedwetting in 10 girls (33%).
Conclusion. Girls with symptoms of detrusor overactivity accompanied by an anterior deflected urinary stream experience UTIs and fever more often than girls with detrusor overactivity and a normal urinary stream. An incision in the external urethral meatus in girls with AdUS and detrusor overactivity seems to be effective treatment for recurrent urinary tract infections, especially febrile ones.
AdUS, meatotomy, detrusor overactivity, UTI.
- Lyon RP, Tanagho EA: distal urethral stenosis in little girls. J Urol 1965, 93, 379–387.
- Lyon RP, Smith DR: distal urethral stenosis. J Urol 1963, 89, 414–421.
- Graham JB, King LR, Kropp KA, Uehling DT: The significance of distal urethral narrowing in young girls. J Urol 1967, 97, 1045–1049.
- Hoebeke P, van Laecke E, Raes A, van Gool JD: Anomalies of the external urethral meatus in girls with nonneurogenic bladder sphincter dysfunction. BJU Int 1999, 83, 294–298.
- Wennergren HM, Öberg BE, Sandstedt P: The importance of leg support for relaxation of the pelvic floor muscles. Scand J Urol Nephrol 1991, 25, 205–213.
- Hendry WF, Stanton SL, Williams DI: Recurrent urinary tract infections in girls: effects of urethral dilatation. Br J Urol 1973, 45, 72–83.
- Kaplan GW, Sammons TA, King LR: A blind comparison of dilatation, urethrotomy and medication alone in the treatment of urinary tract infection in girls. J Urol 1973, 109, 917–919.
- VandeWalle J, Theunis M, Renson C, Raes A, Hoebeke P: Commercial television bladder dysfunction. Acta Urol Bel 1995, 63, 105–11.
- Koff SA: Bladder-sphincter dysfunction in childhood. Urology 1982, 19, 457–460.
- Van Gool JD, De Jonge GA: Urge syndrome and urge incontinence. Arch dis Child 1989, 64, 1629–1634.
- Van Bogaert L: Surgical repair of hypospadias in women with symptoms of urethral syndrome. J Urol 1992, 147, 1263–1264.
- Klijn AJ, Bochove-Overgaauw D, Winkler-Seinstra PL, Dik P, de Jong TPVM: Urethral meatus deformities in girls as a factor in dysfunctional voiding. Neurourol Urodyn 2012, 31, 1161–1164.