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Eur J Pediatr Surg 2015; 25(01): 100-104
DOI: 10.1055/s-0034-1387935
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Bladder Neck Closure in Children: Long-Term Results and Consequences

Sara Hernandez-Martin
1   Pediatric Urology, Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Pedro Lopez-Pereira
2   Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
,
Sergio Lopez-Fernandez
1   Pediatric Urology, Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Rubén Ortiz
1   Pediatric Urology, Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
,
Mercedes Marcos
3   Department of Clinical Analysis, Hospital Universitario La Paz, Madrid, Spain
,
Roberto Lobato
2   Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
,
Maria Jose Martinez-Urrutia
2   Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
,
Enrique Jaureguizar
2   Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
› Author Affiliations
Further Information

Publication History

25 July 2013

02 July 2014

Publication Date:
30 August 2014 (online)

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Abstract

Aim Only few studies have gathered information on the long-term outcomes of children undergoing bladder neck closure (BNC). In the present study, we analyze the long-term results and consequences in this population.

Patients and Methods The medical records of 20 patients (12 males and 8 females), who underwent BNC after several failed procedures to improve urinary incontinence were revised. Exstrophy complex was the underlying diagnose in all the cases: bladder exstrophy in 15 and cloacal exstrophy in 5. The median age of the patients at the time of surgery was 11.5 years (range 4–19 years). Previous surgeries were bladder neck reconstruction in 14 patients, bladder neck injection in 4 patients, and previous BNC in 1 patient. Overall 17 patients had concomitant bladder augmentation. The catheterizable stoma was made with appendix in 14, bowel in 3, and ureter in 3. The nine male patients aged > 18 years at the time of this study received a questionnaire with specific questions on erections, orgasm, and details of ejaculation and were also asked to provide a semen sample.

Results The median follow-up was 10 years (range 2–17 years) and median patient age was 21 years (range 13–32 years). Urinary continence was achieved initially in 16 patients (80%); 4 had a bladder neck fistula, 3 of them underwent surgical revision and achieved dryness. Long-term complications were: bladder stones (eight patients); stomal problems (four stenosis and three leaks); bladder perforation (two patients), and orchitis (one patient). All patients above the age of 18 years reported erections and orgasms although two had medium erectile dysfunction. The ejaculate volume was reported as normal in five, scarce in three, and absent in one, with slow ejection in seven. Only four supplied semen samples and only two showed normal values.

Conclusions BNC is an effective approach to incontinence when other procedures have failed. In the long term, the most frequent complications are those related with catheterizable stoma and stones. The high incidence report of a low fertility index and erectile dysfunction meant further study in a larger cohort.

Keywords

urinary incontinence - bladder exstrophy - bladder neck closure - erectile dysfunction - continent conduit - catheterization
 

  • References

  • 1 Catti M, Lortat-Jacob S, Morineau M, Lottmann H. Artificial urinary sphincter in children—voiding or emptying? An evaluation of functional results in 44 patients. J Urol 2008; 180 (2) 690-693 , discussion 693
    CrossrefPubMedGoogle Scholar
  • 2 Halachmi S, Farhat W, Metcalfe P, Bagli DJ, McLorie GA, Khoury AE. Efficacy of polydimethylsiloxane injection to the bladder neck and leaking diverting stoma for urinary continence. J Urol 2004; 171 (3) 1287-1290
    CrossrefPubMedGoogle Scholar
  • 3 Leadbetter Jr GW. Surgical Correction of Total Urinary Incontinence. J Urol 1964; 91: 261-266
    PubMedGoogle Scholar
  • 4 Purves T, Novak T, King J, Gearhart JP. Modified Young-Dees-Leadbetter bladder neck reconstruction after exstrophy repair. J Urol 2009; 182 (4, Suppl) 1813-1817
    CrossrefPubMedGoogle Scholar
  • 5 Salle JL, McLorie GA, Bägli DJ, Khoury AE. Urethral lengthening with anterior bladder wall flap (Pippi Salle procedure): modifications and extended indications of the technique. J Urol 1997; 158 (2) 585-590
    CrossrefPubMedGoogle Scholar
  • 6 Bauer SB. Neurogenic bladder: etiology and assessment. Pediatr Nephrol 2008; 23 (4) 541-551
    CrossrefPubMedGoogle Scholar
  • 7 Chalmers D, Ferrer F. Continent urinary diversion in the epispadias-exstrophy complex. Semin Pediatr Surg 2011; 20 (2) 102-108
    CrossrefPubMedGoogle Scholar
  • 8 De Troyer B, Van Laecke E, Groen LA, Everaert K, Hoebeke P. A comparative study between continent diversion and bladder neck closure versus continent diversion and bladder neck reconstruction in children. J Pediatr Urol 2011; 7 (2) 209-212
    CrossrefPubMedGoogle Scholar
  • 9 Kavanagh A, Afshar K, Scott H, MacNeily AE. Bladder neck closure in conjunction with enterocystoplasty and Mitrofanoff diversion for complex incontinence: closing the door for good. J Urol 2012; 188 (4, Suppl) 1561-1565
    CrossrefPubMedGoogle Scholar
  • 10 Landau EH, Gofrit ON, Pode D , et al. Bladder neck closure in children: a decade of followup. J Urol 2009; 182 (4, Suppl) 1797-1801
    CrossrefPubMedGoogle Scholar
  • 11 Nguyen HT, Baskin LS. The outcome of bladder neck closure in children with severe urinary incontinence. J Urol 2003; 169 (3) 1114-1116 , discussion 1116
    CrossrefPubMedGoogle Scholar
  • 12 Mitrofanoff P. [Trans-appendicular continent cystostomy in the management of the neurogenic bladder]. Chir Pediatr 1980; 21 (4) 297-305
    PubMedGoogle Scholar
  • 13 Monti PR, Lara RC, Dutra MA, de Carvalho JR. New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology 1997; 49 (1) 112-115
    CrossrefPubMedGoogle Scholar
  • 14 Khoury AE, Agarwal SK, Bägli D, Merguerian P, McLorie GA. Concomitant modified bladder neck closure and Mitrofanoff urinary diversion. J Urol 1999; 162 (5) 1746-1748
    CrossrefPubMedGoogle Scholar
  • 15 Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11 (6) 319-326
    CrossrefPubMedGoogle Scholar
  • 16 Cooper TG, Noonan E, von Eckardstein S , et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update 2010; 16 (3) 231-245
    CrossrefPubMedGoogle Scholar
  • 17 Hoebeke P, De Kuyper P, Goeminne H, Van Laecke E, Everaert K. Bladder neck closure for treating pediatric incontinence. Eur Urol 2000; 38 (4) 453-456
    CrossrefPubMedGoogle Scholar
  • 18 Bergman J, Lerman SE, Kristo B, Chen A, Boechat MI, Churchill BM. Outcomes of bladder neck closure for intractable urinary incontinence in patients with neurogenic bladders. J Pediatr Urol 2006; 2 (6) 528-533
    CrossrefPubMedGoogle Scholar
  • 19 Novak TE, Salmasi AH, Lakshmanan Y, Mathews RI, Gearhart JP. Bladder neck transection for intractable pediatric urinary incontinence. J Urol 2009; 181 (1) 310-314 , discussion 314
    PubMedGoogle Scholar
  • 20 Leslie B, Lorenzo AJ, Moore K, Farhat WA, Bägli DJ, Pippi Salle JL. Long-term followup and time to event outcome analysis of continent catheterizable channels. J Urol 2011; 185 (6) 2298-2302
    CrossrefPubMedGoogle Scholar
  • 21 Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int 2012; 109 (9) 1280-1293
    CrossrefPubMedGoogle Scholar
  • 22 Husmann DA, Rathbun SR. Long-term follow up of enteric bladder augmentations: the risk for malignancy. J Pediatr Urol 2008; 4 (5) 381-385 , discussion 386
    CrossrefPubMedGoogle Scholar
  • 23 Higuchi TT, Granberg CF, Fox JA, Husmann DA. Augmentation cystoplasty and risk of neoplasia: fact, fiction and controversy. J Urol 2010; 184 (6) 2492-2496
    CrossrefPubMedGoogle Scholar
  • 24 Ansari MS, Cervellione RM, Gearhart JP. Sexual function and fertility issues in cases of exstrophy epispadias complex. Indian J Urol 2010; 26 (4) 595-597
    CrossrefPubMedGoogle Scholar