When the bladder outlet is devastated and unrcconstructiblc, appropriate management of the incontinence is urethral closure. In the male patient, this procedure may be approached pcrineally or suprapubicly, with closure of the urethra at the prostate apex or bladder neck .This paper describes the technique and advantages of suprapubic bladder neck closure and the additional steps required to provide a successful outcome. 14 male patients undcnvcnt bladder neck closure for intractable incontinence. 11 had neurogenic bladder, secondary to spinal injury (paraplegic 5, quadriplegic 6), of whom 7 had previously had sphincterotomies. 3 patients had problems following proslatcctomy, 2 associated with radiation. Previous attempts to control incontinence included artificial sphincter (3), Teflon(2), collagcn(l), and pcrincal urethral closurc(2). 6 patients had developed cutaneous fistulae , 1 a urethral diverticulum . and 5 had associated dccubitus ulceration. The bladder neck is exposed through a lower midiinc incision and separated from the prostalic urethra. The posterior bladder neck is mobilized upwards and closed in 2 layers. Omcnlum(9) or reclus fiap(4),were interposed bctween the bladder neck and prostate. 3 patients had a catheterizable stoma constructed and 11 had a suprapubic catheter placed. In 2 patients with massive urelhral loss, a perincal urcihrostomy was formed to fascilitate seminal drainage. 1 irradiated patient (radical prostatectomy, eroded artificial sphincter) did not heal, necessitating subsequent diversion. In all others the bladder neck closed primarily (follow up 3months - Syears). 2 stomas have required revision and one patient developed a transient bowel obstruction. Suprapubic closure of the bladder neck is safe, with good results in this difficult group of patients. The exposure is excellent without need for extensive dissection below the pubis, Interposilional tissue is readily available and bladder drainage (suprapubic catheter or continent stoma) can be provided via the same incision . No problems related to seminal emission were encountered. This approach maintains fertility potential in the spinal cord patient.
|Original language||English (US)|
|Number of pages||1|
|Journal||British Journal of Urology|
|Issue number||SUPPL. 2|
|State||Published - 1997|
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