RECTUS FASCIAL WRAP - EARLY RESULTS OF A MODIFICATION OF THE RECTUS FASCIAL SLING

We describe an operation that increases bladder neck resistance in pat ients with urinary incontinence. It is a modification of the rectus fa scial sling that was designed as an adjunct to augmentation cystoplast y and is used in association with clean intermittent catheterization. The operation is performed by circumferentially wrapping a rectus fasc ial defatted free graft around the bladder neck and suturing it to app ose the bladder neck,. The procedure was done in 17 patients, includin g 10 with myelodysplasia, 3 with sacral lipoma, 3 with bladder exstrop hy and 1 with nonneurogenic neurogenic bladder. Leak point pressure im proved in patients in whom it was measured preoperatively and postoper atively. Complications developed in 5 patients, including difficulty w ith catheterization in 2, ventral hernia at the graft harvest site in 1, bladder calculus in 1 and detrusor hyperreflexia in 1, Early result s with the bladder fascial wrap indicate that it has the ability to im prove continence in patients with a dysfunctional bladder neck who hav e undergone augmentation.