Bladder neck closure in children: long-term results and consequences

Area of Science:

• Pediatric Urology
• Reconstructive Urology

Background:

• Urinary incontinence in children often requires complex surgical management.
• Long-term outcomes of bladder neck closure (BNC) in pediatric patients are not well-documented.

Purpose of the Study:

• To evaluate the long-term results and complications of bladder neck closure (BNC) in children with complex bladder exstrophy.
• To assess the impact of BNC on urinary continence, stomal function, and male sexual function.

Main Methods:

• Retrospective review of 20 pediatric patients (12 male, 8 female) with bladder exstrophy who underwent BNC.
• Analysis of surgical history, concomitant procedures (e.g., bladder augmentation), stoma type, and long-term follow-up data.
• Male patients over 18 years old completed questionnaires on sexual function and provided semen samples.

Main Results:

• Initial urinary continence achieved in 80% of patients, with successful revision for fistula in 3.
• Common long-term complications included bladder stones (8/20), stomal issues (7/20), and bladder perforation (2/20).
• All adult males reported erections/orgasms, but 2 had erectile dysfunction, and 7/9 reported abnormal ejaculation; only 2/4 semen samples were normal.

Conclusions:

• Bladder neck closure (BNC) is an effective salvage procedure for refractory urinary incontinence in children with exstrophy.
• Long-term complications primarily involve stomal issues and stone formation.
• The high incidence of impaired male fertility and erectile dysfunction warrants further investigation in larger cohorts.