Robotic-assisted bladder neck procedures in children with neurogenic bladder

  • Patricio C. Gargollo
  • Lindsay A. WhiteEmail author
Topic Paper



To review the current status of robotic-assisted laparoscopic surgical techniques for bladder neck procedures in children with incontinence secondary to neurogenic bladder.


A comprehensive review of the literature on robotic-assisted bladder neck procedures was conducted, with a focus on articles published in the last 25 years. These data were subsequently compared to published series of open bladder neck procedures and published results from robotic-assisted bladder neck reconstruction series completed at our institution.


The principle bladder neck procedures for incontinence in pediatric patients with neurogenic bladder include: Artificial Urinary Sphincter, Bladder Neck Sling, Bladder Neck Closure, and Bladder Neck Reconstruction. Continence rates range from 60 to 100% with a lack of expert consensus on the preferred procedure (or combination of procedures). Robotic-assisted approaches are associated with longer operative times, especially early in the surgical experience, but demonstrate equivalent continence rates with potential benefits including low interoperative blood loss, improved cosmesis, and decreased intra-abdominal adhesion formation.


Robotic-assisted procedures of the bladder neck are safe, feasible, follow the same steps and principles as those of open surgery and produce equivalent continence rates. Robotic-assisted techniques can be adapted to a variety of bladder neck procedures and safely expanded to selected patients with the previous open abdominal surgery.


Neurogenic bladder Robotic-assisted surgery Bladder neck reconstruction Artificial urinary sphincter Bladder neck sling Bladder neck closure 





Artificial Urinary Sphincter


Bladder Neck Closure


Bladder Neck Reconstruction


Bladder Neck Sling


Clean Intermittent Catheterization




Previous open abdominal surgery


Robotic-assisted laparoscopic artificial urinary sphincter


Robotic-assisted laparoscopic surgery


Authors’ contributions

PCG: protocol/project development, data analysis, and manuscript editing. LAW: data collection, data analysis, and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Bauer SB, Labib KB, Dieppa RA, Retik AB (1977) Urodynamic evaluation of boy with myelodysplasia and incontinence stuart. Urology 10(4):354–362CrossRefPubMedGoogle Scholar
  2. 2.
    Lais A, Kasabian NG, Dyro FM et al (1993) Neurosurgical implications of continuous neuro-urological surveillance of children with myelodysplasia. J Urol 150:1879–1883CrossRefPubMedGoogle Scholar
  3. 3.
    Snodgrass WT, Elmore J, Adams R (2007) Bladder neck sling and appendicovesicostomy without augmentation for neurogenic incontinence in children. J Urol 177(4):1510–1515CrossRefPubMedGoogle Scholar
  4. 4.
    Abrams P (2002) The standardization of terminology of lower urinary tract function: report from the Standardization Sub-committee of the International Continence Society. Neurourol Urodyn 21(2):167–178CrossRefPubMedGoogle Scholar
  5. 5.
    Gargollo PC, Granberg C, Gong E, Tu D, Whittam B, Dajusta D (2018) Complex robotic lower urinary tract surgeries in patients with previous open surgery. J Urol. CrossRefGoogle Scholar
  6. 6.
    Gargollo Patricio C (2015) Robotic-assisted bladder neck repair: feasibility and outcomes. Urol Clin 42(1):111–120CrossRefGoogle Scholar
  7. 7.
    Bagrodia A, Gargollo P (2011) Robot-assisted bladder neck reconstruction, bladder neck sling, and appendicovesicostomy in children: description of technique and initial results. J Endourol 25:1299CrossRefPubMedGoogle Scholar
  8. 8.
    Freilich DA, Penna FJ, Nelson CP et al (2010) Parental satisfaction after open versus robot assisted laparoscopic pyeloplasty: results from modified Glasgow Children’s Benefit Inventory Survey. J Urol 183:704CrossRefPubMedGoogle Scholar
  9. 9.
    Pattaras JG, Moore RG, Landman J et al (2002) Incidence of postoperative adhesion formation after transperitoneal genitourinary laparoscopic surgery. Urology 59:37CrossRefPubMedGoogle Scholar
  10. 10.
    Grimsby Gwen M, Jacobs Micah A, Gargollo Patricio C (2015) Comparison of complications of robot-assisted laparoscopic and open appendicovesicostomy in children. J Urol 194(3):772–776CrossRefPubMedGoogle Scholar
  11. 11.
    Bauer SB (2008) Long-term efficacy of artificial urinary sphincters in children. J Urol 180(2):441CrossRefPubMedGoogle Scholar
  12. 12.
    Simeoni J, Guys JM, Mollard P, Buzelin JM, Moscovici J, Bondonny JM et al (1996) Artificial urinary sphincter implantation for neurogenic bladder: a multi-institutional study in 107 children. Br J Urol 78(2):287–293CrossRefPubMedGoogle Scholar
  13. 13.
    Catti M, Lortat-Jacob S, Morineau M, Lottmann H (2008) Artificial urinary sphincter in children—voiding or emptying? An evaluation of functional results in 44 patients. J Urol 180(2):690–693CrossRefPubMedGoogle Scholar
  14. 14.
    Herndon CA, Rink RC, Shaw MB, Simmons GR, Cain MP, Kaefer M, Casale AJ (2003) The Indiana experience with artificial urinary sphincters in children and young adults. J Urol 169(2):650–654CrossRefPubMedGoogle Scholar
  15. 15.
    Levesque PE et al (1996) Ten-year experience with the artificial urinary sphincter in children. J Urol 156(2):625–628CrossRefPubMedGoogle Scholar
  16. 16.
    Spiess PE, Capolicchio JP, Kiruluta G, Salle JP, Berardinucci G, Corcos J (2002) Is an artificial sphincter the best choice for incontinent boys with Spina Bifida? Review of our long term experience with the AS-800 artificial sphincter. Can J Urol 9(2):1486–1491PubMedGoogle Scholar
  17. 17.
    Castera R et al (2001) 10-Year experience with artificial urinary sphincter in children and adolescents. J Urol 165(6):2373–2376CrossRefPubMedGoogle Scholar
  18. 18.
    Moscardi PRM et al (2017) Robotic-assisted laparoscopic artificial urinary sphincter and MACE procedure on a pediatric patient. J Pediatr Urol 13(5):527–528CrossRefPubMedGoogle Scholar
  19. 19.
    Kryger JV, Gonzalez R, Barthold JS (2000) Surgical management of urinary incontinence in children with neurogenic sphincteric incompetence. J Urol 163(1):256–263CrossRefPubMedGoogle Scholar
  20. 20.
    Snodgrass W, Barber T (2010) Comparison of bladder outlet procedures without augmentation in children with neurogenic incontinence. J Urol 184(4):1775–1780CrossRefPubMedGoogle Scholar
  21. 21.
    Grimsby GM, Menon V, Schlomer BJ, Baker LA, Adams R, Gargollo PC, Jacobs MA (2016) Long-term outcomes of bladder neck reconstruction without augmentation cystoplasty in children. J Urol 195(1):155–161CrossRefPubMedGoogle Scholar
  22. 22.
    Liard A (2001) The Mitrofanoff procedure: 20 years later. J Urol 165(6 Pt 2):2394–2398CrossRefPubMedGoogle Scholar
  23. 23.
    Hoebeke P, De Kuyper P, Goeminne H et al (2000) Bladder neck closure for treating pediatric incontinence. Eur Urol 38(4):453–456CrossRefPubMedGoogle Scholar
  24. 24.
    Kavanagh A et al (2012) Bladder neck closure in conjunction with enterocystoplasty and Mitrofanoff diversion for complex incontinence: closing the door for good. J Urol 188(4):1561–1566CrossRefPubMedGoogle Scholar
  25. 25.
    Gundeti MS et al (2016) A multi-institutional study of perioperative and functional outcomes for pediatric robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy. J Pediatr Urol 12(6):386.e1–386.e5CrossRefGoogle Scholar
  26. 26.
    Murthy P et al (2015) Robot-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: updated interim results. Eur Urol 68(6):1069–1075CrossRefPubMedGoogle Scholar
  27. 27.
    Cole EE, Adams MC, Brock JW 3rd et al (2003) Outcome of continence procedures in the pediatric patient: a single institutional experience. J Urol 170(2 Pt 1):560–563 (discussion: 563) CrossRefPubMedGoogle Scholar
  28. 28.
    Jawaheer G, Rangecroft L (1999) The Pippi Salle procedure for neurogenic urinary incontinence in childhood: a three-year experience. Eur J Pediatr Surg 9(Suppl 1):9–11CrossRefPubMedGoogle Scholar
  29. 29.
    Grimsby GM et al (2016) Perioperative and short-term outcomes of robotic vs open bladder neck procedures for neurogenic incontinence. J Urol 195(4):1088–1092CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric UrologyMayo Clinic and Mayo Medical SchoolRochesterUSA
  2. 2.Mayo Clinic and Mayo Clinic School of Graduate Medical EducationRochesterUSA

Personalised recommendations