Bladder neck incompetence at posterior urethroplasty.

Area of Science:

• Urology
• Reconstructive Surgery
• Pelvic Trauma Management

Background:

• Incompetent bladder neck (BN) significantly complicates posterior urethroplasty, impacting urinary continence.
• Pelvic fracture-related BN injuries, often from direct bone trauma, are distinct from shearing urethral injuries.

Purpose of the Study:

• To outline the diagnosis and management of incompetent bladder neck (BN) during posterior urethroplasty.
• To review treatment options for restoring urinary continence in cases of BN incompetence.

Main Methods:

• Diagnosis involves cystography showing an open rectangular BN and suprapubic cystoscopy revealing a fixedly open BN.
• Treatment strategies include BN reconstruction, artificial sphincters, collagen injections, or bladder flap tubularization.

Main Results:

• The incidence of BN incompetence during posterior urethroplasty is approximately 4.5%.
• Risk factors include pediatric patients, bilateral pubic rami fractures, and initial primary realignment.
• The Young-Dees-Leadbetter procedure for BN reconstruction demonstrates the most successful results.

Conclusions:

• Managing incompetent bladder neck (BN) requires addressing both urethral continuity and urinary continence.
• Reconstruction of the bladder neck (BN) is crucial for successful functional outcomes in these complex cases.