title: Vesicoscopic bladder neck procedure in children: what we have learned from the first series.
abstract: OBJECTIVE
  To assess the results of endoscopic bladder neck procedure on the anterior bladder wall in children.
  
  
  METHODS
  Surgery is done in the lithotomy position using three 5-mm ports. The bladder is insufflated with CO2. A U-shaped incision is made around the bladder neck. A mucosal strip is tabularized around a 12 French catheter and covered with the second layer of mucosa. Twenty procedures were performed on 18 patients (mean age, 9.8 years), and the follow-up period was >1 year (mean, 34 months). Mean operation time was 149 minutes. Twelve patients had neurogenic lower urinary tract dysfunction. Fifteen patients failed earlier bladder neck surgery, predominantly fascia sling suspension. Preoperatively, all patients had low detrusor leak point pressure. Clean intermittent catheterization (CIC) was resumed through the urethra in 11 patients and through a stoma in 6 patients.
  
  
  RESULTS
  Two patients needed conversion because of CO2 leakage. Six patients were dry, and 4 improved in the short term (3-6 months). After 1 year of follow-up, 2 patients were dry, and 6 improved. In the long term, 1 (9%) out of 11 patients who were catheterized through the urethra was dry, and 3 of the 11 patients (27%) improved. Of the 6 patients with a CIC stoma, 1 (17%) was dry, and 3 (50%) improved.
  
  
  CONCLUSIONS
  Endoscopic bladder neck surgery is, for most patients, a minor operation, but the long-term results are disappointing. The construction of a continent channel for CIC can improve the outcome when anterior bladder neck plasty is performed.
authors: Department of Pediatric Urology, Academic Medical Center Amsterdam/University Medical Center of Utrecht, Utrecht, The Netherlands. r.chrzan@amc.nl
authors: Rafal
authors: R
authors: Chrzan
authors: Pieter
authors: P
authors: Dik
authors: Aart J
authors: AJ
authors: Klijn
authors: Caroline F
authors: CF
authors: Kuijper
authors: Marleen M C
authors: MM
authors: van den Heijkant
authors: Tom P V M
authors: TP
authors: de Jong
mesh_terms: D000293:Adolescent; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*