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Modified Young-Dees-Leadbetter bladder neck reconstruction: new concepts about old ideas
F A Ferrer1, Y E Tadros, J Gearhart
1Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Urology
|November 17, 2001
Summary
The Young-Dees-Leadbetter bladder neck reconstruction, refined over 82 years, effectively treats congenital urinary incontinence in select pediatric patients. This surgical technique improves outcomes for lower urinary tract reconstruction.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- The Young-Dees-Leadbetter bladder neck reconstruction has undergone 82 years of evolution.
- Numerous urologic surgeons have contributed to its refinement, enhancing patient outcomes.
Observation:
- Optimal patient selection includes minimal bladder capacity (85 mL) and readiness for postoperative voiding programs.
- Adequate exposure of the bladder and bladder neck is crucial.
- Ureteral reimplantation (cephalotrigonal or cross-trigonal) is performed to mobilize ureters and correct reflux.
Findings:
- A 15x30 mm mucosal template forms the neourethra and bladder neck.
- Demucosalized bladder flaps are closed in a "vest-over-pants" manner over an 8F Firlit tube.
- Ureteral stents and a suprapubic tube are used, omitting a urethral catheter.
Implications:
- The modern Young-Dees-Leadbetter procedure is an effective treatment for congenital urinary incontinence.
- Appropriate patient selection is key to successful lower urinary tract reconstruction.
