Related Experiment Video
Updated: Sep 27, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
The outcome of bladder neck closure in children with severe urinary incontinence
Hiep T Nguyen1, Laurence S Baskin
1Department of Urology, University of California, San Francisco Children's Hospital, USA.
Insights
Bladder neck closure effectively manages severe urinary incontinence in children when other surgeries fail. However, long-term success depends on intermittent catheterization compliance and carries risks of stomal stenosis and bladder stones.
Area of Science:
- Pediatric Urology
- Surgical Management of Incontinence
Background:
- Severe urinary incontinence in children often necessitates complex surgical interventions.
- Previous bladder outlet procedures may fail, requiring alternative management strategies.
Purpose of the Study:
- To evaluate the efficacy and outcomes of bladder neck closure in pediatric patients with intractable urinary incontinence.
- To assess the long-term continence rates and complication profiles following this procedure.
Main Methods:
- Bladder neck closure was performed on 20 pediatric patients with conditions including bladder exstrophy, myelomeningocele, and urogenital sinus anomalies.
- Effectiveness was measured by continence status and need for subsequent surgeries, with a mean follow-up of 5.4 years.
Main Results:
- Initially, 40% of patients achieved dryness at 3 months post-surgery. After further interventions, 85% became continent within 2 years.
- Long-term follow-up revealed that only 40% of patients remained dry after 3 years, with 47% developing stomal leakage.
- Complications included stomal stenosis (30%) and bladder stones (40%); no hydronephrosis or bladder perforation occurred.
Conclusions:
- Bladder neck closure is a viable option for achieving urinary continence in children with refractory incontinence after failed bladder outlet surgeries.
- Patient compliance with intermittent catheterization is crucial for sustained success.
- Increased risk of stomal stenosis and bladder stone formation are significant long-term considerations.
Purpose:
We evaluated the outcome of children who underwent bladder neck closure for the management of severe urinary incontinence.
Materials And Methods:
Bladder neck closure was performed in 12 patients with bladder exstrophy, 4 with myelomeningocele and 4 with urogenital sinus anomalies for severe urinary incontinence that persisted after multiple failed bladder outlet procedures. The effectiveness of bladder neck closure and the need for subsequent surgeries were ascertained.
Results:
Mean followup was 5.4 years (range 1 to 12). At 3 months after surgery 40% of the patients were completely dry, 20% had leakage via the stoma and 40% had a urethral fistula. After additional surgeries 85% of the patients were completely continent 2 years following bladder neck closure (15% declined further surgeries or had an ileal conduit). Of the 15 patients with followup longer than 3 years only 40% remained completely dry, and leakage via the stoma developed in 47% after being dry for 1 year. Repeat urodynamic studies did not show any adverse changes in bladder dynamics in the incontinent patients. Stomal stenosis occurred in 30% of the patients and bladder stones developed in 40%. None of the patients had hydronephrosis or bladder perforation. The early complication of fistula formation and the late development of leakage via the stoma appear to be related in part to compliance with intermittent catheterization.
Conclusions:
Bladder neck closure is an effective method of achieving urinary continence in children in whom other bladder outlet surgery has failed. However, its success is dependent in part upon compliance with intermittent catheterization. Finally children who have undergone bladder neck closure are at an increased risk for stomal stenosis and bladder stones.
