Bladder neck reconstruction in classic XXXX : the role of osteotomy in the development of continence.

@entity1 @entity3226 @entity1494 @entity6877 @entity3832 @entity2096
OBJECTIVE: To assess the role of osteotomy at the time of bladder neck reconstruction (BNR) for continence in classic @entity1494 , in which closure of the pelvic ring and reconstitution of the pelvic diaphragm may affect eventual continence. @entity1 AND METHODS: The results of using osteotomy at the time of BNR in 29 @entity1 were reviewed. The mean bladder capacity before BNR was 76 mL. The indications for osteotomy were a wide pubic @entity6877 and a soft intersymphyseal bar. After osteotomy, all @entity1 were maintained in external fixation and lower-extremity traction for 6-8 weeks. RESULTS: Complications of osteotomy were limited to a partial @entity2096 (one @entity1 ) and delayed union of fragments (one @entity1 ). Complications of BNR included @entity3832 (five @entity1 ) and @entity3226 (six @entity1 ). Continence results were modest, with 11 of 29 @entity1 (38%) dry during the day (dry interval >3 h) and eight of 29 (28%) dry at night. Eight @entity1 had daytime dry intervals of approximately 3 h. The mean preoperative bladder capacity in @entity1 who were dry both day and night was 101 mL. CONCLUSIONS: The preoperative bladder capacity remains a key determinant for the attainment of continence after BNR in the reconstruction of classic @entity1494 . Osteotomy allows pelvic closure and thus improves cosmesis of the mons and stabilizes the BNR in @entity1 with a soft intersymphyseal bar, but seems to have no effect on continence when performed at the time of bladder neck plasty.
