The Young-Dees-Leadbetter bladder neck repair for neurogenic incontinence

Purpose: We review our experience with the Young-Dees-Leadbetter bladder ne ck repair among patients with neurogenic incontinence. Materials and Methods: Between 1978 and 1997, 25 girls and 13 boys with a m ean age of 10.5 years (range 5 to 25) underwent a standard Young-Dees-Leadb etter bladder neck repair for neurogenic incontinence. Of the 38 patients 2 6 had undergone prior urological surgery, including bladder neck surgery in 6 and bladder augmentation in 4. A primary Young-Dees-Leadbetter bladder n eck repair was performed in 24 patients, a secondary Young-Dees-Leadbetter procedure in 6 and a primary Young-Dees-Leadbetter procedure with periureth ral silicone sheath placement in 8. Results: Of the 38 patients 30 (79%) are dry, 7 (18%) are partially dry and 1 remains incontinent. Total or partial dryness was achieved after the ini tial repair in 26 cases (68%), while 8 required an additional procedure and 3 required more than 2 procedures to achieve continence. All patients who underwent silicone sheath placement were initially dry but incontinence dev eloped subsequently in 5 due to sheath erosion. Of the 38 patients 35 (92%) ultimately required bladder augmentation. Conclusions: The management of neurogenic incontinence remains difficult. S uccess with the Young-Dees-Leadbetter procedure in our experience nearly al ways requires augmentation cystoplasty. The majority of patients will achie ve continence after the initial procedure, and persistent incontinence can frequently be cured with further bladder neck surgery.