Bladder exstrophy: Comparison of anatomical bladder neck repair with innervation preserving sphincteroplasty versus Young-Dees-Leadbetter bladder neck reconstruction

Abstract

Aim:To evaluate the outcome of innervation preserving sphincteroplasty along with anatomical bladder neck reconstruction (IPS-ABNR) compared to classic Young-Dees-Leadbetter (YDL) bladder neck reconstruction in exstrophy with insufficient bladder capacity requiring detubularized-ileocystoplasty.Materials and Methods:Sixteen male patients of exstrophy bladder who required ileocystoplasty from 2004 to 2010 were randomized into group A (n = 7) and group B (n = 9). After detubularized-ileocystoplasty with Mitrofanoff stoma and ureteric reimplantation in all, group A received YDL bladder neck repair while group B received IPS-ABNR repair through a midline scrotoperineal approach. Outcome measurement included operative and postoperative problems, continence, and upper tract status.Results:In group A, two had incompetent bladder neck with gross incontinence, while four had a dry interval of more than 3 h without the ability of voiding per urethra. In group B, seven patients had dry interval of more than 3 h with an ability of urethral voiding and midstream holding in five.Conclusions:Exstrophy patients requiring augmentation cystoplasty and repaired with IPS-ABNR can achieve dynamic bladder outlet resistance with adequate leak point pressure and ability to void voluntarily with midstream holding capability. The children had the satisfaction of voiding per urethra with ability to stop in midstream similar to that in normal children.

Case Report: Long Term Follow Up of Bladder Exstrophy Repaired in Stages with Complete Urinary Continence

“…Young-Dees-Leadbetter (YDL) technique may achieve urinary continence and complete bladder evacuation, however intravesical pressure may be raised; low-pressure reservoir can be achieved by augmentation cystoplasty, so a combination of these procedures is advisable when the residual bladder is small. These patients usually maintain continence on CIC program, however a few will still suff er from continuous wetting, in which case appendic-ovesicostomy (Mitrofanoff ) procedure with frequent CIC through the exteriorized appendicular tip is indicated [8] . Finally, in patients who fail to achieve continence following anatomic reconstructions, urinary diversion may be useful [5] .…”

Histopathology of intersymphyseal band and its correlation with continence in bladder exstrophy repair

“…The added importance of the external urethral sphincter in continence has been studied by Kureel et al [13,14]. Their method includes anatomical repair along with innervation preserving sphincteroplasty of the skeletal muscle of the urogenital diaphragm by dissection in the subperiosteal plane.…”

New horizon in understanding of pediatric surgical diseases

“…Clean intermittent catheterization is a valuable tool to achieve low-pressure evacuation in these patients as also in patients with neuropathic bladder. [ 8 9 10 ]…”