Bladder neck reconstruction with omentum, silicone and augmentation cystoplasty--a preliminary report

A new method of bladder neck reconstruction in which the Young-Dees tube was wrapped with omentum and silicone was used in 39 patients during a 20-month period. In 43 per cent of the patients simultaneous augmentation cystoplasty also was performed. The silicone was intended to maintain the Young-Dees tube length and to allow safe artificial sphincter cuff placement later when necessary. Among exstrophy patients 85 per cent of those who underwent augmentation and 15 per cent of those who did not are dry. A dry exstrophy patient had a remarkably easy sphincter cuff placement 6 months after bladder neck reconstruction. Of the epispadias patients 25 per cent are dry and 58 per cent have a dry interval of 2 hours or less. Erosion of silicone into the Young-Dees tube occurred in the first 5 patients in whom a thick (0.01-inch) wrap was used and in 14 per cent of those in whom a thin (0.005-inch) sheet was used. The details of this technique and modifications to reduce further the complication rate are discussed.