Reconstruction of the lower urinary tract for neurogenic bladder: lessons from the adolescent age group

Of 42 adolescents with neurogenic bladder who presented for lower urinary tract reconstruction, 4 patients with severe spina bifida were unfit for major surgery. Five patients had a simple undiversion; 4 of these had a poor outcome because of unpredicted sphincter incontinence (1 patient) or instability (3). A total of 26 patients had an enterocystoplasty. All 7 patients who had a substitution cystoplasty had a good result, as did 3 males with a clam cystoplasty. Nine of 16 females had a poor result from a clam procedure. In 3 the problem lay with self-catheterisation difficulties. One each had persistent hyper-reflexia and sphincter incontinence. Four had hyper-reflexia on sexual intercourse. Overall, 42% of females had problems from the retained bladder segment. Seven patients had continent urinary diversions. The results were good, although 2 Kock nipples required revision. Surgery was well tolerated. There was a 21% re-operation rate for complications. Pre-operative investigation correctly predicted sphincter competence and the need for self-catheterisation in 79 and 86% respectively.