[TRANSVAGINAL BLADDER NECK CLOSURE FOR PARAPLEGIC ADULTS - REPORT OF TWO CASES]

We report our initial experiences with transvaginal bladder neck closure for two females with a devastated bladder neck. In each, the bladder neck was closed following a circumferential dissection and the suture line covered using an anterior vaginal flap, with urine draining via a suprapubic cystostomy tube. (Case 1) A female in her twenties was presented with urinary incontinence. The patient had been paraplegic since childhood and initially managed with intermittent catheterization. Later, severe incontinence developed, and Foley catheter was placed. At presentation, the urethra and bladder neck were widely lacerated. Primary closure of the bladder neck and fascial sling placement were performed but she remained incontinent. Transvaginal bladder neck closure was thus performed, and she became continent. (Case 2) A female in her forties came to us with urinary incontinence. This patient had also been paraplegic since childhood and was initially maintained on intermittent catheterization as initial management, after which a Foley catheter was placed. A bladder neck laceration was noted before surgical repair, thus transvaginal bladder neck closure with simultaneous suprapubic cystostomy tube placement was performed. (Conclusion) This is the initial report of patients in Japan who underwent transvaginal bladder neck closure. The procedure was effective in both cases and should be considered for incontinent women with an irreparable bladder outlet.