This document discusses various surgical procedures for bladder neck reconstruction to treat neurogenic bladder dysfunction. It describes several techniques such as flap valve mechanisms, bulking agents, and artificial urinary sphincters that aim to tighten the bladder neck. No single procedure is best for all patients and options must be tailored based on each person's condition and goals. While many techniques have shown success rates over 90% for continence, factors like learning curves, variable definitions of success, and prior reconstruction attempts can influence outcomes. Complications include incontinence, fistulas, and tissue necrosis, so careful patient selection and follow-up is important.

1. BLADDER NECK RECONSTRUCTION
Sunil Kumar
JIPMER, Puducherry

2. Indication
• Neurogenic dysfunction secondary to spinal
dysraphism.
• Exstrophy, bilateral ectopic ureters, and
ureteroceles,

3. Mechanism
 Tightening of the bladder neck
 Construction of a flap valve mechanism
 Placement of artificial or autologous bulking agents,
 The artificial urinary sphincter.
The selected option should
be individualized to the patient’s pathologic process,
needs, and personal goal

4. • The major disadvantage of flap valves is that the
valve will not allow leakage with high intravesical
pressures, potentiating renal damage. (Level 1)
• Therefore, these procedures can be dangerous
to the patient who is not totally committed to
follow catheterization recommendations.(Grade
A)

5.  Young-Dees-Leadbetter Repair (Urethral
lengthening+Detrusor back up)
 Tanagho procedure (Urethral lenghtening)
 Kroppe procedure (Urethral Lengthening+Flap valve
mechanism)
 Pippi-Salle Procedure (anterior bladder onlay flp)
 Bladder Neck Division
• Fascial Sling
• Bladder Neck Bulking Agents
• Artifiial Urinary Sphincter

6. No single option is best for all patients
(Kryger et al, 2000; Cole et al,
2003; Lemelle et al, 2006; Dave et al, 2008a).

7. Compairability?
• learning curve
• lack of a true, consistent definition of
“success” and “continence,”
• Consideration of patients with and without
concomitant bladder augmentation,
• evaluation of small populations of patients
with mixed pathologic condition

8. • Bladder neck and urethral reconstruction for
continence in patients who had previous
attempts at repair has resulted in less success.
• Presumably this relates to tissue scarring with
the loss of elasticity and contractility

9. Tanagho procedure

12. Young-Dees-Leadbetter Repair

25. Kropp procedure
– Main problem is
catheterisation

26. • Initial complications of Kroppe procedure
included
persistent incontinence,
urethrovesical fitula, and
 partial necrosis of the intravesical neourethra

27. • Snodgrass (1997) examined the results in 23
children,
22 of whom had neurogenic sphincter
incompetence and noted
continence in more than 90% of the children

32. Pippi Salle Procedure

36. Jawaheer and Rangecroft (1999) reported a
diurnal continence rate of 61% for 3 hours or
longer with the Salle procedure.
However, only 44% of their patients were dry
through the night.
Less trouble with catheterization has occurred
relative to the Kropp technique, and it rarely
remains a problem.
Continence rates have not been quite as high in
most series
Rink et al, 1994;Mouriquand et al, 1995; Cole et al, 2003).

43. • Mitchell and Rink described the addition of
external support and compression achieved
through the placement of a silicone sheath
around the reconstructed bladder neck.
• This was somewhat done to establish a plane for
future placement of an artificial sphincter cuff, if
necessary.
-erosion b/c thick sheet
– Thin sheet by Quimby and colleagues

58. Thank You