title: Bladder neck closure and suprapubic tube placement in a debilitated patient population.
abstract: OBJECTIVE
  Bladder neck closure (BNC) with suprapubic tube (SPT) placement is a method of bladder management for patients with neurogenic bladders (NGB). We evaluated our experience at one institution.
  
  
  METHODS
  We conducted a retrospective chart review of patients who received BNC with SPT placement from 1999 to 2008.
  
  
  RESULTS
  Twenty-nine patients (24 females and 5 males, average age 53.4 +/- 9.6 years) underwent BNC with SPT placement. Cause of NGB was multiple sclerosis (48%), spinal injury (28%), or myelodysplasia (17%). All but one were dependent on caregivers for activities of daily living. Preoperative urodynamics studies were performed on 23 patients. Retropubic BNC was performed in 26 of 29 patients. Two females had a transvaginal approach, and one male had a perineal approach. Early (<90 days) postoperative complication rate was 52%. Persistent urine leakage was present in eight patients: two peristomal leakage and six urethral leakage. All three non-retropubic BNC had postoperative fistulas (P = 0.01). Catheter complications were associated with seven of the eight urinary leaks (P = 0.01).
  
  
  CONCLUSIONS
  BNC with SPT is a method of bladder management in the NGB population, particularly suited to those with a low functional status. Fistula rates are significantly higher with non-retropubic BNC (P = 0.01). Poor catheter care in the postoperative period is associated with postoperative urinary leakage (P = 0.01).
authors.affiliation: University of Washington, Seattle, Washington 98195, USA. vginger@u.washington.edu
authors.forename: Van Anh T
authors.initials: VA
authors.lastname: Ginger
authors.forename: Jane L
authors.initials: JL
authors.lastname: Miller
authors.forename: Claire C
authors.initials: CC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods