Bladder neck transection for intractable pediatric urinary incontinence
Thomas E Novak1, Amirali Hassanzadeh Salmasi, Yegappan Lakshmanan
1Division of Pediatric Urology, James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. tnovak4@jhmi.edu
Insights
Bladder neck transection surgery effectively treats intractable urinary incontinence in children, achieving a 98% continence rate after revisions. This procedure is a viable option for complex cases with damaged bladders.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Intractable urinary incontinence in children often requires complex surgical solutions.
- Previous reconstructive attempts may fail, necessitating advanced interventions.
Purpose of the Study:
- To evaluate the indications, technique, and outcomes of bladder neck transection in pediatric patients.
- To assess the efficacy and safety of this procedure for intractable urinary incontinence.
Main Methods:
- Retrospective review of 76 pediatric patients (1996-2006) undergoing bladder neck closure.
- All patients had concomitant augmentation cystoplasty and a catheterizable stoma.
- Analysis of demographics, operative details, complications, and long-term outcomes.
Main Results:
- Initial continence achieved in 86% of patients with over 12 months follow-up (n=50).
- Final continence rate reached 98% after revisions for primary failures.
- Complications included stones (30%) and new hydronephrosis (8 renal units); no spontaneous bladder ruptures.
Conclusions:
- Bladder neck transection with augmentation and a continent stoma is effective for severe bladder outlet damage and incontinence.
- This approach is suitable when other reconstructive methods have failed or are unlikely to succeed.
- Risks of poor renal outcomes and bladder perforation appear minimal with this technique.
Purpose:
We report the indications, technique and outcome of a large series of children who underwent bladder neck transection for intractable urinary incontinence.
Materials And Methods:
We retrospectively reviewed demographics, operative details, complications and outcomes of 76 patients (47 males, 29 females) who underwent bladder neck closure at our institution between 1996 and 2006. Mean patient age at the time of the procedure was 12 years, 10 months. The most common diagnosis was bladder exstrophy. Of the patients 31 had undergone prior bladder neck reconstruction (30) or sling repair (1). All patients underwent concomitant augmentation and creation of a catheterizable stoma.
Results:
A total of 50 patients had more than 12 months of followup (mean 44, range 12 to 128). Continence was achieved initially in 86% of the patients (43 of 50). Of the 7 primary failures 2 leaked via the urethra and 5 via the stoma. Six of these patients achieved dryness with revision, for a final continence rate of 98%. A single renal unit suffered significant loss of function during this period. New, nonobstructive hydronephrosis developed in 8 additional renal units. Stones developed in 30% of the patients. There were no spontaneous bladder ruptures.
Conclusions:
Bladder neck transection in combination with enterocystoplasty and creation of a continent catheterizable stoma is an effective approach to incontinent cases with severely damaged bladder outlets and poor quality bladders in which other reconstructive approaches either have failed or are deemed likely to fail. Specific concerns regarding the risk of poor renal outcomes and perforation seem unwarranted at present.
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