Related Experiment Video
Updated: Aug 30, 2026
Nerve-sparing Mid-urethral Obstruction (NeMO) in Female Small Rodents
Published on: April 25, 2017
Bladder neck cinch for pediatric neurogenic outlet deficiency
Charles E Bugg1, David B Joseph
1Division of Urology, University of Alabama at Birmingham and Childre's Hospital, Alabama 35233, USA.
Insights
The rectus fascia bladder neck cinch procedure for neurogenic bladder outlet deficiency achieved continence in 60% of pediatric patients. While effective, this technique did not demonstrate superiority over existing bladder neck slings.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Neurogenic Bladder Management
Background:
- Urinary incontinence in children with neurogenic outlet deficiency is often managed with fascial bladder neck slings.
- Existing slings typically apply only partial pressure around the bladder neck, limiting their effectiveness.
Purpose of the Study:
- To evaluate the efficacy of a rectus fascia bladder neck cinch procedure.
- This technique aims to increase outlet resistance by applying circumferential pressure and elevation around the bladder neck.
Main Methods:
- Fifteen children with spina bifida and neurogenic intrinsic sphincter deficiency underwent a rectus fascia bladder neck cinch during augmentation cystoplasty.
- A 1-1.5 cm width of rectus fascia was harvested, cinched around the bladder neck, and secured.
Main Results:
- The study included 14 girls and 1 boy aged 4-17 years with poorly compliant or small capacity bladders.
- At 10-36 months follow-up, 60% (9 out of 15) of the children achieved dryness, defined as no leaks or pads for 4 hours post-catheterization and overnight continence.
- All patients continued clean intermittent catheterization post-operatively.
Conclusions:
- The rectus fascia bladder neck cinch is an effective surgical option for managing urinary incontinence in children with neurogenic bladder outlet deficiency.
- However, the procedure's effectiveness was comparable to existing bladder neck slings, not superior.
- The authors noted a subsequent modification of their technique due to results not fully meeting expectations.
Purpose:
The fascial bladder neck sling achieves continence in 50% to 90% of children with neurogenic outlet deficiency. Most slings apply only partial pressure around the bladder neck. We evaluated the effectiveness of a rectus fascia bladder neck cinch which applies circumferential pressure around the bladder neck and elevation as a means of increasing outlet resistance.
Materials And Methods:
Fifteen children with spina bifida underwent a fascial bladder neck cinch procedure at the time of augmentation cystoplasty. A 1 to 1.5 cm width of variable length rectus fascia was harvested and a vertical slit was made in 1 end. The fascia was "cinched" tightly around the bladder neck and secured to the symphysis or rectus fascia.
Results:
The 14 girls and 1 boy ranged in age range from 4 to 17 years. All children had neurogenic intrinsic sphincter deficiency and a poorly compliant and/or small capacity bladder. Followup ranged from 10 to 36 months (followup in 12 greater than 1 year). Postoperatively, all children perform clean intermittent catheterization. At the last followup 8 girls and the boy (60%) were dry (no leak and no pads at 4 hours from the last catheterization and dry throughout the night).
Conclusions:
Rectus fascia used as a bladder neck cinch is effective but no better than other bladder neck slings for decreasing urinary incontinence. The bladder neck cinch appears to be an acceptable addition to the technique of fascial slings. However, we have subsequently changed our technique because these results did not meet our expectations.
Related Concept Videos
01:23Urinary Bladder
In males, the bladder is situated in front of the rectum, while in females, it is positioned anterior to the vagina and uterus. The bladder floor contains an inverted triangular area called the trigone, defined by the two ureteric...
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating urine...
01:22Aneurysm IV: Nursing Management
01:19Anatomy of the Genitourinary System II: Bladder and Urethra
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography