Young-Dees-Leadbetter bladder neck reconstruction for sphincteric urinary incontinence: the value of augmentation...

Young-Dees-Leadbetter bladder neck reconstruction was performed in five females and two males with bladder exstrophy, two females and one male with epispadias, and two females with congenital short urethra. Eight patients had simultaneous augmentation colocystoplasty (7 exstrophy, 1 female epispadias), seven of whom are continent for three hours or more. Two patients void spontaneously and five are managed by clean intermittent catheterization (CIC) with which there were considerable problems in the beginning. Three of the four patients in whom simultaneous bladder augmentation was not undertaken remained incontinent because of small hypocompliant bladders. One has had a secondary augmentation cystoplasty and two may need it. Young-Dees-Leadbetter bladder neck reconstruction is a satisfactory operation for sphincteric urinary incontinence despite problems with CIC. However, bladder capacity may be considerably reduced after reconstruction. Augmentation cystoplasty should be considered not only in exstrophy patients undergoing bladder neck reconstruction but also in patients with other abnormalities.