Introduction. The modern Young-Dees-Leadbetter bladder neck reconstruction
is a procedure that has evolved during the past 82 years. During this time,
the modifications and contributions of several urologic surgeons have impr
oved the procedure and ultimate patient outcomes. We review the evolution a
nd describe in detail our version of the Young-Dees-Leadbetter bladder neck
reconstruction procedure.
Technical Considerations. Optimally, patients should have a minimal bladder
capacity of 85 mL and be mature enough to participate in a postoperative v
oiding program. Adequate radical exposure of the lateral aspects of the bla
dder and bladder neck are important. Cephalotrigonal or cross-trigonal uret
eral reimplantation is typically performed to mobilize the ureters in relat
ion to the proposed bladder neck and correct reflux. A mucosal template 15
mm wide by 30 mm long is created that will serve as the reconstituted poste
rior urethra and bladder neck. Triangular lateral bladder mucosal wedges ar
e marked and demucosalized. The neourethra is closed over an 8F Firlit tube
. The demucosalized flaps are brought over the urethra sequentially in a "v
est-over-pants" fashion with the final layer consisting of suspension sutur
es. Finally, ureteral stents and a suprapubic tube are used, but no urethra
l catheter is left in place.
Conclusions. The modern Young-Dees-Leadbetter bladder neck reconstruction i
s the result of the contributions of various urologic surgeons during 82 ye
ars. When patients are appropriately selected, it is an effective method of
lower urinary tract reconstruction in cases of congenital urinary incontin
ence. (C) 2001, Elsevier Science Inc.