title: Preperitoneoscopic approach for bladder neck sling suspension in a boy: preliminary experience.
abstract: OBJECTIVE
  This report is aimed at describing our preliminary experience with the preperitoneoscopic approach to the bladder neck for rectus fascial sling suspension in neurogenic bladder.
  
  
  METHODS
  A 13-year-old boy with spina bifida was admitted to our institution to treat bladder incontinence. A bladder neck suspension and bladder augmentation was planned. The preperitoneal space was progressively gained by blunt dissection under direct vision (laparoscopy with a single left subcostal trocar), and a total of three preperitoneal ports were inserted. Dissection of the bladder proved to be relatively easy, and the retropubic space as well as the deep pelvis were safely exposed. Owing to the excellent endoscopic visualization, the bladder was dissected downward from the rectum. Once complete mobilization of the bladder neck was achieved, an umbilical tape was passed around the proximal urethra to create an adequate passage for the fascial sling.
  
  
  RESULTS
  The preperitoneoscopic procedure lasted 2 hours. No complications occurred. A good daytime dry period was achieved at the 4-month follow-up.
  
  
  CONCLUSIONS
  Direct visualization of the bladder neck and minimal dissection to the deep pelvis are the key points of this approach. Provided certain technical details are considered, the minimally invasive preperitoneal access is a valuable alternative to the open approach for the rectus fascial sling procedure, particularly when dealing with male patients. Technical advances will, presumably, lead to a complete minimally invasive treatment of urinary incontinence in male patients with spina bifida.
authors.affiliation: Pediatric Surgery Department, G. Gaslini Institute, University of Genoa, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.forename: Piero
authors.initials: P
authors.lastname: Buffa
authors.forename: Michele
authors.initials: M
authors.lastname: Torre
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini-Prato
authors.forename: Nicola
authors.initials: N
authors.lastname: Disma
authors.forename: Stefano
authors.initials: S
authors.lastname: Avanzini
authors.forename: Edoardo
authors.initials: E
authors.lastname: Guida
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rapuzzi
authors.forename: Sara
authors.initials: S
authors.lastname: Costanzo
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.forename: Samuele
authors.initials: S
authors.lastname: Leggio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Jasonni
mesh_terms: D000293:Adolescent; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010537:Peritoneum / Q000601:surgery; D019919:Prosthesis Implantation / Q000379:methods*; D016135:Spinal Dysraphism / Q000150:complications; D053825:Suburethral Slings; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*