Monday, November 10, 2008

The management of the failed bladder neck procedure in patients with spina bifida

Walker RD. The management of the failed bladder neck procedure in patients with spina bifida. BJU International (Journal of the British Association of Urological Surgeons).. 2003 Oct;92 Suppl 1:35-7. Review.

Urinary incontinence secondary to decreased outlet resistance is common in patients with spina bifida. Most often these patients require both augmentation cystoplasty and a procedure to increase resistance at the bladder neck. The choices for operations to increase bladder neck resistance include the artificial urinary sphincter (AUS), the Kropp and Leadbetter procedures (and variations) and bladder neck wraps or slings. Bladder neck injection with bulking agents has also been used but the long-term results are unknown and most authors do not address what to do when the procedure fails. While the short-term success with each of the open procedures has been good, the longer-term success has been less satisfactory. The purpose of this study is twofold; to review the author's experience with those patients in whom a rectus fascial wrap has failed and in the discussion, to review how others have
managed the failures in procedures that they have advocated.

PMID: 12969007

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