Back to 2014 Fall Congress Meeting Abstracts

BACKGROUND: The Kropp and Salle procedures are reported to have good short-term outcomes for managing neuropathic urinary incontinence. However, few studies have assessed long-term results. This study aims to illustrate the long-term outcomes of Kropp and Salle procedures at our institution, including dryness, secondary interventions for incontinence and complications and using the urethra to catheterize.

METHODS: We retrospectively reviewed consecutive patients undergoing Kropp and Salle procedures at our institution (1983-2012). Patients with <6 months follow-up or prior bladder neck continence procedures were excluded. We collected patient data, particularly on postoperative dryness per urethra at 4h and 3h intervals, as well as secondary interventions. Non-parametric tests were used for statistical analysis.

RESULTS: Thirty-eight patients had a Kropp (K: 30 boys) and 12 had a Salle procedure (S: 8 boys). Patients underwent surgery at similar median ages (K: 7.4 years old vs. S: 8.7, p=0.51), with similar follow-up (6.9 years vs. 10.3, respectively, p=0.10). Most patients had: myelomeningocele, a prior or concomitant bladder augmentation (K: 73.7%, S: 58.3%) and catheterizable channel (K: 81.6%, S: 50.0%). Differences in outcomes between Kropp and Salle procedures did not reach statistical significance. The majority of patients did not have additional bladder neck procedures for dryness (K: 84.2%, S: 66.7%). Of this group, K: 78.1% and S: 75.0% were dry for ≥4h, K: 93.8% and S: 87.5% were dry for ≥3h between catheterizations. Of the minority of patients who underwent additional bladder neck procedures for dryness (K: 15.8%, S: 33.3%), most achieved dryness for ≥4h (K: 66.7%, S: 100%) and ≥3h (100% for both). Among patients without an initial catheterizable channel, 57.1% of the patients after a Kropp procedure and 33.3% after a Salle had one subsequently created. Among patients without augmentation, half underwent delayed augmentation (K: 50.0%, S: 40.0%). Ultimately, most patients required a secondary intervention under anesthesia for incontinence or a complication (K: 79.0%, S: 66.7%) and few patients catheterized per urethra (K: 10.5%, S: 33.3%).

CONCLUSIONS: In our hands, the Kropp and Salle procedures attain dryness at 75-78% at 4h intervals and 88-94% at 3h intervals without undergoing additional bladder neck procedures. Few patients required subsequent bladder neck procedures to achieve dryness.