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The INSIDE-OUT longitudinal technique for bladder neck closure in children: A simplified and innovative approach
Antonio Macedo1, Sérgio Leite Ottoni2, Débora Laena Barroso Sacoman2
1Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil; Department of Urology, CACAU-NUPEP, São Paulo, Brazil.
Introduction:
The article presents the INSIDE-OUT longitudinal technique for bladder neck closure in children, a simplified approach aimed at improving outcomes in pediatric patients, particularly those with myelomeningocele. Traditionally, these patients undergo bladder neck plasty or sling procedures, which, while potentially preserving bladder function, achieve continence rates of approximately 50 %. In contrast, the new INSIDE-OUT technique boasts a success rate exceeding 90 %.
Methods:
The method begins with a midline incision of the bladder, allowing for internal exposure of the bladder neck. A Foley catheter is inserted and traction applied while plastic tubes are positioned in the ureters to facilitate transection of the bladder neck. The technique involves circumferential dissection of the bladder neck from the inside, creating flaps that are elevated to skin level. Closure occurs in two layers, using specific sutures for mucosal and seromuscular layers.
Discussion:
Results show a continence rate exceeding 95 % after over a decade of implementation. We believe that the INSIDE-OUT technique should be more widely considered in complex bladder reconstructions, emphasizing the need to educate patients about the risks associated with improper catheterization. This innovative approach promises better outcomes for children facing complex urinary issues.
