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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.
Insights
The INSIDE-OUT technique for bladder neck closure in children offers superior continence rates (over 95%) compared to traditional methods. This simplified surgical approach is particularly beneficial for pediatric patients with myelomeningocele, improving outcomes in complex bladder reconstructions.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Myelomeningocele often necessitates complex bladder management.
- Traditional bladder neck procedures yield suboptimal continence rates (~50%).
- A novel technique, INSIDE-OUT, is presented for improved pediatric bladder neck closure.
Purpose of the Study:
- To introduce and evaluate the INSIDE-OUT longitudinal technique for bladder neck closure in children.
- To compare the efficacy of the INSIDE-OUT technique with traditional methods in achieving urinary continence.
- To highlight the potential of this technique in complex pediatric bladder reconstructions.
Main Methods:
- The INSIDE-OUT technique involves a midline bladder incision for internal exposure of the bladder neck.
- Circumferential dissection from the inside, creating flaps elevated to skin level.
- Two-layer closure using specific sutures for mucosal and seromuscular layers, with ureteral stenting and Foley catheter traction.
Main Results:
- Sustained continence rates exceeding 95% observed over a decade of implementation.
- Demonstrates significantly higher success rates compared to traditional bladder neck plasty or sling procedures.
- Indicates a promising alternative for complex bladder reconstructions in pediatric populations.
Conclusions:
- The INSIDE-OUT technique represents a significant advancement in pediatric bladder neck closure.
- Wider consideration of this technique is recommended for complex bladder reconstructions.
- Patient education on proper catheterization is crucial to mitigate associated risks.
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.
