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Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures
Konrad M. Szymanski, MD MPH, Richard C. Rink, MD, Benjamin Whittam, MD, Joshua D. Ring, MD, Rosalia Misseri, MD, Martin Kaefer, MD, Mark P. Cain, MD.
Riley Hospital for Children, Indianapolis, IN, USA.

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.


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