Bladder neck closure with lower urinary tract reconstruction: technique and long-term followup

Bladder neck closure (BNC) is an important component of reconstructive urological surgery, especially in the management of neurogenic bladder. To our knowledge we present the largest series of patients who have undergone this procedure.

A total of 39 patients with lower urinary tract (LUT) dysfunction secondary to neurogenic bladder underwent transabdominal BNC and simultaneous LUT reconstruction between 1988 and 2002. Charts were reviewed and patients were retrospectively interviewed to ascertain demographics, previous urological surgeries, perioperative data, postoperative results and complications.

Mean postoperative followup was 36.9 months (range 7 to 173). Concomitant procedures included ileovesicostomy in 19 patients (49%), augmentation enterocystoplasty with continent cutaneous stoma in 19 (49%) and revision of a previous Mitrofanoff appendicovesicostomy in 1. The overall complication rate was 31% with a vesicourethral fistula in 6 patients (15%), of whom 4 required eventual transabdominal or transvaginal surgical correction. No other problems directly related to BNC were identified. Patients were followed by serial renal ultrasound and abdominal x-ray with upper tract maintenance seen in all patients.

Bladder neck closure with simultaneous urinary diversion is a highly effective, well tolerated treatment for many pathological processes of the LUT. Risks for prolonged urethral leakage include high pressure systems, prior bladder neck surgery and noncompliance with catheter/drain management. These data support our belief that a high degree of success with an acceptable complication rate is attainable with careful adherence to surgical technique, proper patient selection, appropriate early postoperative management and rigid surveillance.