TANAGHO BLADDER NECK RECONSTRUCTION IN THE TREATMENT OF ADULT INCONTINENCE

We studied the effectiveness of tubularized bladder neck reconstructio n in the treatment of 8 patients with complex incontinence using urody namic and clinical methods. The patients had undergone Tanagho bladder neck reconstruction within the last 10 years. Three of the 8 patients were judged unsuitable for artificial sphincter implantation because of severe scarring, and loss of urethral and vaginal tissue. There wer e 7 women with epispadias or severe urethral damage as a consequence o f obstetrical or gynecological procedures. Five patients underwent 7 c oncurrent procedures at the time of bladder neck reconstruction, inclu ding colposuspension (4), and closure of a fistula involving the bladd er neck (1) and urethra (1) plus vaginal reconstruction (1). Of 8 pati ents 5 (63%) were completely continent and satisfied, 2 underwent ilea l conduit diversion (1 because of incontinence and 1 refused clean int ermittent self-catheterization), and 1 is incontinent and awaiting fur ther- treatment. The best results were noted in patients with a health y bladder and periurethral tissues. Four of 5 patients (80%) deemed po tentially suitable for artificial urinary sphincter insertion were sat isfied compared to only 1 of 3 (33%) unsuitable for artificial urinary sphincter insertion. The Tanagho bladder neck reconstruction is a use ful addition to the procedures that may be used by the reconstructive urological surgeon in the treatment of carefully selected patients wit h complex incontinence, particularly in women with epispadias who for various reasons may wish to avoid the long-term potential complication s of an artificial urinary sphincter.