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• W2100032151 abstract "No AccessJournal of UrologyPediatric Urology1 Jan 2009Bladder Neck Transection for Intractable Pediatric Urinary Incontinenceis accompanied byIs Bladder Neck Transection Ever Really a Success? Thomas E. Novak, Amirali Hassanzadeh Salmasi, Yegappan Lakshmanan, Ranjiv I. Mathews, and John P. Gearhart Thomas E. NovakThomas E. Novak More articles by this author , Amirali Hassanzadeh SalmasiAmirali Hassanzadeh Salmasi More articles by this author , Yegappan LakshmananYegappan Lakshmanan More articles by this author , Ranjiv I. MathewsRanjiv I. Mathews More articles by this author , and John P. GearhartJohn P. Gearhart More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.09.036AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We report the indications, technique and outcome of a large series of children who underwent bladder neck transection for intractable urinary incontinence. Materials and Methods: We retrospectively reviewed demographics, operative details, complications and outcomes of 76 patients (47 males, 29 females) who underwent bladder neck closure at our institution between 1996 and 2006. Mean patient age at the time of the procedure was 12 years, 10 months. The most common diagnosis was bladder exstrophy. Of the patients 31 had undergone prior bladder neck reconstruction (30) or sling repair (1). All patients underwent concomitant augmentation and creation of a catheterizable stoma. Results: A total of 50 patients had more than 12 months of followup (mean 44, range 12 to 128). Continence was achieved initially in 86% of the patients (43 of 50). Of the 7 primary failures 2 leaked via the urethra and 5 via the stoma. Six of these patients achieved dryness with revision, for a final continence rate of 98%. A single renal unit suffered significant loss of function during this period. New, nonobstructive hydronephrosis developed in 8 additional renal units. Stones developed in 30% of the patients. There were no spontaneous bladder ruptures. Conclusions: Bladder neck transection in combination with enterocystoplasty and creation of a continent catheterizable stoma is an effective approach to incontinent cases with severely damaged bladder outlets and poor quality bladders in which other reconstructive approaches either have failed or are deemed likely to fail. Specific concerns regarding the risk of poor renal outcomes and perforation seem unwarranted at present. References 1 : Bladder neck closure in association with continent urinary diversion. J Urol1995; 154: 883. Link, Google Scholar 2 : Bladder neck closure for treating pediatric incontinence. Eur Urol2000; 38: 453. Google Scholar 3 : Concomitant bladder neck closure and Mitrofanoff diversion for the management of intractable urinary incontinence. J Urol1995; 154: 886. Link, Google Scholar 4 : Concomitant modified bladder neck closure and Mitrofanoff urinary diversion. J Urol1999; 162: 1746. Link, Google Scholar 5 : The outcome of bladder neck closure in children with severe urinary incontinence. J Urol2003; 169: 1114. Link, Google Scholar 6 : Long-term results of suprapubic bladder neck closure for treatment of the devastated outlet. Urology2005; 66: 311. Google Scholar 7 : Continent urinary diversion and the exstrophy-epispadias complex. J Urol2003; 169: 1102. Link, Google Scholar 8 : Long-term followup of patients after redo bladder neck reconstruction for bladder exstrophy complex. J Urol2006; 176: 1138. Link, Google Scholar 9 : Salvage procedures to achieve continence after failed bladder exstrophy repair. J Urol2008; 179: 304. Link, Google Scholar 10 : Techniques to create continence in the failed bladder exstrophy closure patient. J Urol1993; 150: 441. Link, Google Scholar 11 : The multiple reoperative bladder exstrophy closure: what affects the potential of the bladder?. Urology1996; 47: 240. Crossref, Medline, Google Scholar 12 : Determinants of continence in the bladder exstrophy population: predictors of success?. Urology2001; 57: 774. Crossref, Medline, Google Scholar 13 : Is long-term bladder deterioration inevitable following successful isolated bladder outlet procedures in children with neuropathic bladder dysfunction?. J Urol2008; 179: 1991. Link, Google Scholar 14 : Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence. J Urol1978; 120: 40. Link, Google Scholar 15 : Tissue glues and nonsuturing techniques. Curr Opin Urol2007; 17: 396. Google Scholar Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byMaruf M, Manyevitch R, Michaud J, Jayman J, Kasprenski M, Zaman M, Benz K, Eldridge M, Trock B, Harris K, Wu W, Di Carlo H and Gearhart J (2019) Urinary Continence Outcomes in Classic Bladder Exstrophy: A Long-Term PerspectiveJournal of Urology, VOL. 203, NO. 1, (200-205), Online publication date: 1-Jan-2020.Kavanagh A, Afshar K, Scott H and MacNeily A (2012) Bladder Neck Closure in Conjunction with Enterocystoplasty and Mitrofanoff Diversion for Complex Incontinence: Closing the Door for GoodJournal of Urology, VOL. 188, NO. 4S, (1561-1566), Online publication date: 1-Oct-2012.Smith E, Kaye J, Lee J, Kirsch A and Williams J (2010) Use of Rectus Abdominis Muscle Flap as Adjunct to Bladder Neck Closure in Patients With Neurogenic Incontinence: Preliminary ExperienceJournal of Urology, VOL. 183, NO. 4, (1556-1560), Online publication date: 1-Apr-2010.Related articlesJournal of Urology9 Nov 2018Is Bladder Neck Transection Ever Really a Success? Volume 181Issue 1January 2009Page: 310-314 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsurinary incontinencemeningomyeloceleurologic surgical proceduresurinary diversionbladder exstrophyMetricsAuthor Information Thomas E. Novak More articles by this author Amirali Hassanzadeh Salmasi More articles by this author Yegappan Lakshmanan More articles by this author Ranjiv I. Mathews More articles by this author John P. Gearhart More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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