BLADDER NECK RECONSTRUCTION - LONG-TERM FOLLOW-UP OF RECONSTRUCTION WITH OMENTUM AND SILICONE SHEATH

Purpose: In 1986 we reported the placement of a silicone sheath sandwi ched between layers of omentum around a newly reconstructed bladder ne ck. We now present long-term followup of 94 cases of silicone sheath b ladder neck reconstruction. Materials and Methods: A total of 94 silic one sheaths was placed in 84 patients between August 1983 and October 1992. We retrospectively reviewed our results and divided the reconstr uctions into 3 groups according to modifications in surgical technique . We report the results of each modification and current recommendatio ns for use. Results: Each sequential modification of silicone sheath b ladder neck reconstruction significantly reduced the risk of erosion f rom 100%, 32% and 7%, respectively (p <0.05). Erosion was independent of patient age, sex, pathological condition or whether bladder neck re construction was a repeat procedure. Patients who had silicone sheath erosion did not have different continence or loss of urethral continui ty than those with no erosion. In 13 patients (16%) artificial sphinct er placement was clearly facilitated by the silicone sheath. Conclusio ns: Modifications in the surgical technique of silicone sheath placeme nt around a reconstructed bladder neck have resulted in a decrease in the erosion rate to 7%. The primary benefit of silicone sheath placeme nt is ease of subsequent sphincter placement. Currently we reserve sil icone sheath placement for a small subset of patients who are most lik ely to benefit from subsequent artificial sphincter placement.