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Updated: Jul 4, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Current status of bladder neck reconstruction
Sumit Dave1, Joao L Pippi Salle
1Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Finding the ideal surgical option for pediatric urinary incontinence remains challenging. Current bladder outlet procedures, often requiring bladder augmentation, highlight the need for improved diagnostic criteria and outcome assessments.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Urinary Incontinence Management
Background:
- Urinary incontinence in children presents a significant clinical challenge.
- Surgical interventions for bladder outlet dysfunction are diverse and evolving.
Purpose of the Study:
- To review recent (last 3 years) literature on bladder outlet procedures for pediatric urinary incontinence.
- To evaluate the current landscape of surgical options and their outcomes.
Main Methods:
- Systematic literature review of studies published within the last three years.
- Analysis of reported outcomes for various bladder outlet procedures, including slings and injections.
- Comparison of different surgical techniques and their efficacy.
Main Results:
- Multiple bladder outlet procedures exist, often necessitating bladder augmentation.
- Modifications to existing techniques like bladder wrap slings and Kropp-Salle procedures are noted.
- Long-term data on bladder neck injections and preliminary results for bladder exstrophy repairs are presented.
Conclusions:
- Achieving urinary continence in children is difficult and remains a challenge for surgeons.
- There is no single ideal surgical option currently available.
- Standardized definitions of continence and improved preoperative criteria are needed for better outcome evaluation.
Purpose Of Review:
This paper reviews the literature over the last 3 years on bladder outlet procedures for children with urinary incontinence. The multitude of procedures and need for concomitant bladder augmentation indicates that there is no ideal surgical option for these children.
Recent Findings:
The results of bladder neck slings with or without bladder augmentation have been reported in some key studies during this review period. Several modifications of the bladder wrap around sling and modifications of the Kropp-Salle procedure are described. Long-term results of bladder neck injections are highlighted. Preliminary results of complete primary repair of bladder exstrophy are compared with those of staged repair.
Summary:
Achieving urinary continence is difficult and continues to challenge the reconstructive surgeon. Standardized definition of dryness and further efforts to search for preoperative criteria to define the etiology of incontinence are needed to better assess outcomes.
