Urethral lengthening with anterior bladder wall flap for urinary incontinence: a new approach.
Urethral irregularity (impeding catheterization) and failure to achieve continence are common complications in surgery for urinary incontinence. We describe a surgical technique using an anterior bladder wall flap that is sutured to the posterior wall in an onlay fashion creating a flap valve mechanism. Experimental work in dogs demonstrated a significant increase in the leak point pressure in the surgical group when compared to controls (p = 0.019). Voiding cystourethrography and bladder inspection demonstrated an anterior flap valve with no fistula formation in all animals. Histological examination showed a viable anterior bladder wall flap in all cases. This technique was then applied to 6 patients with neurogenic bladder and low urethral resistance that failed to resolve with medical treatment. Urinary continence was achieved in 4 patients. In 1 patient a vesicourethral fistula developed 3 months postoperatively, since the mother failed to catheterize for 12 hours. This technique is a useful alternative in the treatment of urinary incontinence.
Salle
J L
JL
Division of Pediatric Surgery and Urology, Hospital de Clinicas de Porto Alegre, Hospital de Criança Conceicão, Porto Alegre, Brazil.
de Fraga
J C
JC
Amarante
A
A
Silveira
M L
ML
Lambertz
M
M
Schmidt
M
M
Rosito
N C
NC
D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D005260:Female; D006801:Humans; D008297:Male; D013524:Surgical Flaps / Q000379:methods; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*