The rectus myofascial wrap in the management of urethral sphincter incompetence

Objective  To review our experience with a modified rectus/pyramidalis myofascial sling, described more than a century ago for treating refractory urinary incontinence in children with neurogenic sphincteric incompetence. Patients and methods  Thirty‐seven patients (23 females and 14 males, aged 8–21 years) presented with urinary incontinence which failed to respond to medical treatment. In 36 patients the cause of the incontinence was a neurogenic bladder; one patient had sustained a traumatic injury to the bladder neck and urethra. Patient selection was based on videocysto‐urethrographic detection of an incompetent bladder neck, and a low maximum closure pressure during urethral pressure profilometry. The bladder was augmented in 33 of the 37 patients. Results  Of the 37 patients, 34 (92%) are dry between catheterizations; the follow‐up was 0.5–10 years. Two of the male patients continued to have persistent incontinence requiring bladder neck closure and creation of a continent stoma. One of the female patients developed stress incontinence after 4 years of being dry, with a rectus sling. Conclusion  The rectus myofascial sling provides long‐term satisfactory dry intervals between catheterizations in patients with neurogenic sphincteric incompetence. The cinch‐wrap modification appears to enhance the occlusive effect of the sling, particularly in males.