Improved results using a modification of the Young-Dees-Leadbetter bladder neck repair.
Forty-seven patients with primary total incontinence underwent bladder neck reconstruction (BNR) between 1978 and 1988. This included 31 patients with exstrophy/epispadias, 14 with myelomeningocele and 2 with caecoureteroceles. The patients were divided into 5 groups based on the type of BNR: Group 1--standard Young-Dees-Leadbetter (YDL) BNR; Group 2--YDL+Silastic sheath; Group 3--modified YDL; Group 4--Kropp BNR; Group 5--other BNRs. Group 1 included 18 patients with a 45% primary continence failure rate, a 44% reoperation rate and only a fair ability to void spontaneously after BNR. There were 11 patients in Group 3 with a 9% primary continence failure rate, a 27% reoperation rate and excellent post-operative emptying. None of the 3 patients in Group 4 was incontinent post-operatively, but they all required reoperation and had poor post-operative emptying. We feel that the modified YDL BNR provides better overall voiding and continence with less morbidity than the other bladder neck/urethral reconstructive procedures.
Department of Urology (Paediatric Division), Indiana University Hospital, Indianapolis.
J A
JA
Jones
M E
ME
Mitchell
R C
RC
Rink
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014554:Urination; D014572:Urology / Q000379:methods