Concomitant bladder neck closure and Mitrofanoff diversion for the management of intractable urinary incontinence

In a 7-year period 28 patients 1 to 20 years old have undergone bladder neck closure in conjunction with Mitrofanoff diversion for the management of severe incontinence. Surgery was performed as a salvage procedure in 19 patients and as a primary anti-incontinence procedure in 9. At a mean followup of 29 months 27 of 28 patients (96%) were totally continent, requiring no pads. Bladder neck closure was primarily successful in 24 of 28 patients (86%) and 25 (89%) had stable upper tracts. Five patients had bladder calculi and 5 required stomal revisions. One child had a bladder perforation associated with blunt trauma. Bladder neck closure and Mitrofanoff diversion were done without bladder augmentation in 11 cases and augmentation was performed previously or concurrently in the remainder. Four patients who did not initially undergo augmentation required later augmentation (2 for hydronephrosis and 2 for persistent incontinence). We conclude that bladder neck closure in conjunction with Mitrofanoff diversion is highly efficacious in achieving continence in a highly complex subgroup of patients with intractable urinary leakage. With careful patient selection and diligent followup total continence can be achieved in this most difficult patient population.