Bladder neck closure for treating pediatric incontinence

Aims of Study: In order to evaluate the effects of bladder neck closure (BN C) for treatment of pediatric incontinence, on the quality of life of Those children, we reviewed the files of 17 children who underwent this procedur e during the last 5 years. Information on previous surgery before BNC, cont inence and complications after BNC and patient satisfaction are gathered. Material and Methods: During the study period, 17 children (9 male, 8 femal e) underwent BNC with continent diversion. Ten children (5 male, 5 female) suffered neurogenic incontinence in meningomyelocele, 5 children (4 male, 1 female) had bladder exstrophy, 1 girl suffered iatrogenic incontinence aft er treatment of an ectopic ureterocele and 1 girl suffered structural incon tinence after pelvic fracture. Previous surgery for incontinence was done i n 12 children with 36 procedures. Primary BNC was done in 5 children. For c ontinent diversion the appendix was used in 13, the ureter in 2, a Monti pr ocedure in 1, and an ileal valve in 1. In 9 children, ileal bladder augment ation was performed at the time of BNC. Four children were augmented before . Mean age at time of operation was 13.5 years. Mean follow-up is 35 months . Results: After BNC, all patients were completely dry. One girl suffered som e stomal incontinence during the night. This disappeared after recent bladd er augmentation. Patient satisfaction is extremely high after surgery. All patients feel happy with their stoma and do not regret the choice they made . As for complications, urinary tract infections were seen in 9 patients. S tomal complications were seen in 8 patients. Three patients had some diffic ulty with catheterization, which could be solved with dilatation. Appendice al polyps, which could be removed under local anesthesia, were seen in 3 an d stomal stenosis which needed re-intervention in 2. in 1 patient, three re visions of the stoma were done, in the other patient, two surgical correcti ons. Out of 8 patients showing stomal complications, only 2 needed revision under anesthesia. All complications are seen in the first 6 months after t he continent diversion. Conclusions: We present a series of patients who underwent BNC for treatmen t of incontinence, BNC is the ultimate bladder neck reconstruction. However , regarding the high success rate, the low complication rate and the high p atient satisfaction, we must consider BNC as an important procedure for the reconstructive surgeon. If reconstruction fails, closure must be considere d. Compared to most other procedures for bladder neck reconstruction, BNC g ives the highest continence rate. Good patient compliance and strict medica l follow-up of the upper tract is mandatory in these patients. Copyright (C ) 2000 S. Karger AG, Basel.