Current status of bladder neck reconstruction

Abstract

Achieving urinary continence is difficult and continues to challenge the reconstructive surgeon. Standardized definition of dryness and further efforts to search for preoperative criteria to define the etiology of incontinence are needed to better assess outcomes.

Urologic care of adults with spina bifida

“…Slings have been reported to have a higher success rate in females [35]. They have not produced as reliable a result in males despite many published modifi cations [34]. One advantage of the sling over other bladder outlet surgical procedures is that there is less of an impact on the detrusor leak point pressure [36].…”

“…As a primary therapy, results are generally not acceptable, but about one third to one half of patients will have signifi cant continence improvements when agents are used after a previous bladder outlet procedure. Higher injection volume, an antegrade injection technique, and prior bladder augmentation seem to yield improved overall results [34].…”

“…A variety of procedures to enhance the bladder outlet have been used [34]. Endoscopic treatment with injectable bulking agents has had mixed success rates and durability.…”

Surgical and nonsurgical treatment options for pediatric neurogenic bladder

“…We do prefer to utilize Young-Dees-Leadbetter bladder neck reconstruction, which consists of reimplantation of the ureters to a higher position in the bladder, and tubularization of the mucosa over a 5F feeding tube. Some prefer to use a modified Kropp future science group Surgical & nonsurgical treatment options for pediatric neurogenic bladder Review bladder neck tube or Pippe-Salle bladder neck reconstruction [5,21]. Both procedures involve utilization of the anterior bladder wall strip that is subsequently tubularized over the catheter and brought through the submucosal tunnel.…”

“…In children with poor urethral outlet resistance, bladder neck reconstruction may be necessary to obtain continence [5,21]. The literature is filled with a myriad of papers describing different methods to increase urethral resistance, while at the same time allowing ease of catheterization.…”