Bladder Neck Closure for Treating Pediatric Urinary Incontinence

Kim, Kwang Myung; Kim, Tae hun; Lee, Sang Wook

Abstract

PURPOSE: Our aim was to evaluate the efficacy of a bladder neck closure (BNC) for the treatment of incontinence in children with a neurogenic bladder.
MATERIALS AND METHODS
Between January 1995 and July 2002, 14 children (8 boys and 6 girls) underwent a BNC, with continent diversion. Information on the continence stati and complications following the BNC were evaluated. The mean age at the time of the operation and the follow-up period were 9.7 years, ranging from 6 to 22, and 21 months, respectively. All children suffered from neurogenic incontinence related to spinal bifida. The BNC were performed as primary procedures in 11 children and as secondary procedures in 3. During surgery, the bladder neck was transected and the bladder opening and urethral stump closed in two layers. A Mitrofanoff diversion, with appendix, was performed in all patients.
RESULTS
After the BNC, all the patients were completely dry. As for the related complications with the BNC, no leakages or fistulae were seen in any of the patients. Bladder stones were seen in 2 patients, postoperative ileus in 2 and symptomatic urinary tract infection in 1. Stomal complications were seen in 2 patients. One patient each had some pain with the catheterization and mild stomal stenosis, but they all improved with no additional intervention.
CONCLUSIONS
With the high success, and low complication, rates, it is concluded that a BNC, in conjunction with bladder augmentation and Mitrofanoff diversion, is highly efficacious in achieving dryness in pediatric urinary incontinence, when used as a primary, as well as a salvage procedure.