Bladder neck closure in association with continent urinary diversion

Area of Science:

• Urology
• Surgical Techniques

Background:

• Bladder neck closure is not standard in continent urinary diversion.
• Leaving the native bladder neck intact is often preferred when possible.
• Poor intrinsic outlet resistance necessitates bladder neck closure for continence.

Purpose of the Study:

• To evaluate the efficacy of bladder neck closure in patients undergoing simultaneous bladder augmentation and continent urinary diversion with poor intrinsic outlet resistance.
• To present a specific surgical technique for reliable bladder neck closure in this challenging patient group.

Main Methods:

• Retrospective review of 13 patients (6 male, 7 female) aged 8-22 years treated between 1990-1993.
• Patients had diagnoses including myelomeningocele, bladder exstrophy, leiomyosarcoma, pelvic trauma, or conjoined twins.
• Evaluation included voiding cystourethrography and urodynamics; surgical technique involved bladder neck division, 2-layer closure, and omental interposition.

Main Results:

• All 13 patients had failed previous treatments or catheterization programs and suffered diurnal incontinence.
• Initial success was achieved in 12 of 13 cases, with all 13 achieving success subsequently.
• The described technique of bladder neck closure proved reliable in this cohort.

Conclusions:

• Bladder neck closure is a necessary component of continent urinary diversion for select patients with inadequate intrinsic outlet resistance.
• A technique of bladder neck division, 2-layer closure, and omental interposition offers a reliable solution for achieving continence.
• This approach can successfully manage incontinence in complex pediatric and young adult cases.