Bladder neck transection for intractable pediatric XXXX .

@entity1 @entity3041 @entity322 @entity1494
PURPOSE: We report the indications, technique and outcome of a large series of @entity1 who underwent bladder neck transection for intractable @entity322 . MATERIALS AND METHODS: We retrospectively reviewed demographics, operative details, complications and outcomes of 76 @entity1 (47 males, 29 females) who underwent bladder neck closure at our institution between 1996 and 2006. Mean @entity1 age at the time of the procedure was 12 years, 10 months. The most common diagnosis was @entity1494 . Of the @entity1 31 had undergone prior bladder neck reconstruction (30) or sling repair (1). All @entity1 underwent concomitant augmentation and creation of a catheterizable stoma. RESULTS: A total of 50 @entity1 had more than 12 months of followup (mean 44, range 12 to 128). Continence was achieved initially in 86% of the @entity1 (43 of 50). Of the 7 primary failures 2 leaked via the urethra and 5 via the stoma. Six of these @entity1 achieved dryness with revision, for a final continence rate of 98%. A single renal unit suffered significant loss of function during this period. New, nonobstructive @entity3041 developed in 8 additional renal units. Stones developed in 30% of the @entity1 . There were no spontaneous @entity1494 . CONCLUSIONS: Bladder neck transection in combination with enterocystoplasty and creation of a continent catheterizable stoma is an effective approach to incontinent cases with severely damaged bladder outlets and poor quality bladders in which other reconstructive approaches either have failed or are deemed likely to fail. Specific concerns regarding the risk of poor renal outcomes and perforation seem unwarranted at present.
