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Updated: Jun 20, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Bladder neck closure in children: a decade of followup
Ezekiel H Landau1, Ofer N Gofrit, Dov Pode
1Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel. hezil@ekmd.huji.ac.il
Insights
Bladder neck closure is safe and effective for long-term urinary continence and upper tract preservation. Patients demonstrate good compliance with clean intermittent catheterization, with correctible complications.
Area of Science:
- Pediatric Urology
- Reconstructive Urology
Background:
- Bladder neck closure requires lifelong clean intermittent catheterization (CIC).
- Concerns exist regarding patient well-being and compliance with long-term CIC.
- Noncompliance can lead to serious complications like hydronephrosis and infection.
Purpose of the Study:
- To analyze long-term outcomes of bladder neck closure.
- To assess patient compliance with CIC, upper tract preservation, continence, and complications.
- To evaluate the need for subsequent procedures.
Main Methods:
- Retrospective analysis of patients followed for at least 10 years post-bladder neck closure.
- Inclusion criteria: minimum 10-year follow-up after bladder neck closure.
- Data collected on compliance, upper tract status, continence, and complications.
Main Results:
- 12 patients (7 boys, 5 girls) with a mean age of 7.0 years underwent bladder neck closure.
- Mean follow-up was 12.4 years; all patients performed CIC 4-6 times daily.
- Excellent continence achieved, with hydronephrosis stable or improved in most; low, correctible morbidity.
Conclusions:
- Long-term CIC compliance is good following bladder neck closure.
- Bladder neck closure offers excellent long-term safety for upper tracts and continence.
- The procedure is associated with low, correctible morbidity.
Purpose:
Bladder neck closure necessitates lifelong clean intermittent catheterization. Concerns have been raised regarding well-being and compliance in patients on long-term clean intermittent catheterization. Noncompliance may result in subsequent hydronephrosis, incontinence, infection, cystolithiasis and perforation. We analyzed our long-term results with bladder neck closure followed at least 10 years for patient compliance with clean intermittent catheterization, upper tract preservation, continence, complications and subsequent procedures.
Materials And Methods:
All patients followed at least 10 years after bladder neck closure were included in this study.
Results:
Seven boys and 5 girls with a mean age of 7.0 years and urinary incontinence underwent bladder neck closure and continent urinary diversion between 1993 and 1998. The primary diagnosis was exstrophy in 5 patients, spinal dysraphism in 3, trauma in 2, sacral agenesis in 1 and a duplicated hindgut in 1. Mean followup was 12.4 years (range 10 to 14). All patients performed clean intermittent catheterization 4 to 6 times daily. Hydronephrosis improved or remained stable in the 11 patients who underwent bladder augmentation. Mild new hydronephrosis developed in 1 patient and resolved after increasing clean intermittent catheterization frequency. Bladder neck closure successfully cured incontinence in all of the last 6 patients who underwent modified bladder neck closure with a posterior bladder neck flap, while 2 of the earlier 6 bladder neck closures required revision for a subsequent 100% success rate. Additional operations were required in 6 patients. To our knowledge this is the longest followup after bladder neck closure reported in the literature.
Conclusions:
Patient compliance with long-term clean intermittent catheterization is good after bladder neck closure. Bladder neck closure provides excellent long-term safety for the upper urinary tract and continence. It is associated with relatively low morbidity, which is correctible.
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