Bladder wall pedicle wraparound sling for neurogenic urinary incontinence in children

Purpose: To improve the results of current bladder neck reconstruction a modification was developed to provide tapering, circumferential compression and suspension of the bladder neck. Materials and Methods: Nine female and 15 male patients with spinal dysraphism and incontinence, despite intermittent catheterization and pharmacotherapy, and low outlet resistance underwent surgery. The procedure involves wrapping a pedicle strip of anterior bladder wall around the bladder neck and suspending it to the pubic symphysis. Results: All 9 girls are completely continent, whereas 10 boys are dry and 5 have stress incontinence after 9 to 14 months of followup. Subjective symptoms correlate with changes in leak point pressure. Conclusions: This technique is an efficacious addition to bladder augmentation in female patients with poor compliance and low outlet resistance.