title: Use of rectus abdominis muscle flap as adjunct to bladder neck closure in patients with neurogenic incontinence: preliminary experience.
abstract: OBJECTIVE
  Vesicoureteral fistula is a well-known potential complication following bladder neck closure for neurogenic incontinence. Various maneuvers, including omental interposition, have been described to prevent this problem. Unfortunately omentum is not always available or feasible for use. We describe the surgical anatomy and use of a rectus abdominis muscle flap as an adjunctive maneuver during bladder neck closure to correct or prevent development of bladder neck fistula.
  
  
  METHODS
  We performed a retrospective chart review of all patients at our institution undergoing rectus abdominis muscle flap by a single surgeon (EAS). Patient demographics, indications for surgery, intraoperative and postoperative complications, and long-term efficacy were assessed. Cadaveric dissection was also performed to gain a greater understanding of the surgical anatomy relevant to this procedure.
  
  
  RESULTS
  In 6 patients with neurogenic bladder dysfunction a rectus abdominis muscle flap was interposed between the bladder neck and urethral stump at bladder neck closure. There were no intraoperative or postoperative complications associated with this procedure. At a mean followup of 45.5 months (range 18 to 120) all 6 patients were continent of urine. There have been no urinary fistulas related to use of the rectus abdominis muscle flap. Cadaveric dissections confirmed the inferior epigastric artery to be the dominant and readily mobile blood supply of the rectus abdominis muscle flap.
  
  
  CONCLUSIONS
  The rectus abdominis muscle flap is easily harvested without significant risk of morbidity and offers a well vascularized tissue for coverage of a bladder neck closure when an omental flap is not available.
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30342, USA. smithea@aol.com
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Smith
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kaye
authors.forename: John Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D002102:Cadaver; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D017568:Rectus Abdominis / Q000637:transplantation; D012189:Retrospective Studies; D013524:Surgical Flaps; D001747:Urinary Bladder Fistula / Q000517:prevention & control; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods