Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of Current Bladder Outlet Techniques for Neurogenic Bladder Dysfunction

  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This article evaluates the literature published from 2016 to 2023 regarding bladder outlet techniques for neurogenic bladder dysfunction in children.

Recent Findings

Continence rates following open bladder neck reconstruction remain highly variable, ranging from 17 to 96% in recent series. Augmentation cystoplasty at the time of bladder neck reconstruction appears to improve both postoperative continence and bladder compliance in longer-term follow-up, with a large percentage of children undergoing isolated bladder neck procedures progressing to augmentation cystoplasty within a few years of reconstruction. Artificial urinary sphincter placement is safe and effective in children with neurogenic bladder but need for device replacement is inevitable. Catheterization through a continent catheterizable channel improves device longevity. Continence outcomes following management with primary bladder neck sling or bladder neck injection are poor, but slings and bladder neck injections paired with bladder neck reconstruction appear to improve continence outcomes. Robot-assisted interventions are safe, efficacious, and more time intensive than open procedures, though operative times improve with surgeon experience. Use of chemodervation agents at the time of bladder outlet procedures decreases postoperative opiate usage, and combined antegrade/retrograde bladder neck injections may improve procedure outcomes.

Summary

Following a systematic literature review through the PubMed database, a total of seventeen relevant manuscripts were published from 2016 to 2023. This article provides an overview of the surgical considerations for bladder outlet procedures, a description of technical considerations for open and minimally invasive approaches, and a review of surgical outcomes using information gained from these studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AC :

Augmentation cystoplasty

AUS :

Artificial urinary sphincter

BNI :

Bladder neck injection

BNR :

Bladder neck reconstruction

NGB :

Neurogenic bladder

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Weaver JK, Coplen DE, Knight BA, et al. Clinical outcomes after increasing bladder outlet resistance without augmentation cystoplasty in neurogenic bladder. J Pediatr Urol. 2021;17(2):235.e1-235.e7. This article provides excellent data regarding long term BNR outcomes in a very large patient cohort.

    Article  CAS  PubMed  Google Scholar 

  2. Smith MC, Strine AC, DeFoor WR, et al. Need for botulinum toxin injection and bladder augmentation after isolated bladder outlet procedure in pediatric patients with myelomeningocele. J Pediatr Urol. 2020;16:32.e1-32.e8.

    Article  PubMed  Google Scholar 

  3. Grimsby GM, Menon V, Schlomer BJ, et al. Long-Term Outcomes of Bladder Neck Reconstruction without Augmentation Cystoplasty in Children. J Urol. 2016;195:155–61.

    Article  PubMed  Google Scholar 

  4. Fuchs ME, Beecroft N, McLeod DJ, Dajusta DG, Ching CB. Intraoperative Onabotulinumtoxin-A Reduces Postoperative Narcotic and Anticholinergic Requirements After Continent Bladder Reconstruction. Urology. 2018;118:183–8.

    Article  PubMed  Google Scholar 

  5. Bowen DK, Cheng EY, Hirsch J, et al. A fresh “slant” on modified Mitchell bladder neck reconstruction: A contemporary single-institution experience. Front Pediatr. 2022;10:933481. This article provides evidence supporting a modified BNR technique that has proven very efficacious and durable, along with anatomic illustrations and surgical recommendations.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Haecker FM, Mettler A, Mack A. Current Concepts in Endoscopic Bladder Neck Injection: Combined Antegrade and Retrograde Endoscopic Injection of the Bladder Neck in Children with Neurogenic Bladder. Children (Basel). 2022;9:449.

    PubMed  Google Scholar 

  7. Paret F, Leclair MD, Karam G, Rigaud J, Baron M, Perrouin-Verbe MA. Long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children. Neurourol Urodyn. 2023;42:355–65.

    Article  CAS  PubMed  Google Scholar 

  8. Jones JA, Mitchell ME, Rink RC. Improved results using a modification of the Young-Dees-Leadbetter bladder neck repair. Br J Urol. 1993;71:555–61.

    Article  CAS  PubMed  Google Scholar 

  9. Kropp KA, Angwafo FF. Urethral lengthening and reimplantation for neurogenic incontinence in children. J Urol. 1986;135:533–6.

    Article  CAS  PubMed  Google Scholar 

  10. Mouriquand PD, Sheard R, Phillips N, White J, Sharma S, Vandeberg C. The Kropp-onlay procedure (Pippi Salle procedure): a simplification of the technique of urethral lengthening. Preliminary results in eight patients. Br J Urol. 1995;75:656–62.

    Article  CAS  PubMed  Google Scholar 

  11. Faure A, Hery G, Mille E, et al. Long-Term Efficacy of Young-Dees Bladder Neck Reconstruction: Role of the Associated Bladder Neck Injection for the Treatment of Children With Urinary Incontinence. Urology. 2017;108:166–70.

    Article  PubMed  Google Scholar 

  12. Szymanski KM, Rink RC, Whittam B, et al. Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures. J Pediatr Urol. 2016;12:403.e1-403.e7.

    Article  CAS  PubMed  Google Scholar 

  13. Malhotra NR, Wallis MC, Allen CM, Cartwright PC, Lau GA. Continence outcomes following a modification of the Mitchell bladder neck reconstruction in myelomeningocele: A single institution experience. J Pediatr Urol. 2020;16:653.e1-653.e8.

    Article  PubMed  Google Scholar 

  14. Bronnimann E, Alova I, Vatta F, Blanc T, Lottmann H. What makes the bladder neck sling procedure a success in a selected population of children and adolescents? A STROBE-compliant investigation. J Pediatr Urol. 2022;18:187–95.

    Article  PubMed  Google Scholar 

  15. Delgado-Miguel C, Munoz-Serrano A, Amesty V, et al. Artificial urinary sphincter in congenital neuropathic bladder: Very long-term outcomes. Int J Urol. 2022;29:692–7. This article provides good very long-term evidence regarding the durability of AUS devices along with a helpful KM survival curve.

    Article  PubMed  Google Scholar 

  16. Khene ZE, Paret F, Perrouin-Verbe MA, et al. Artificial Urinary Sphincter in Male Patients with Spina Bifida: Comparison of Perioperative and Functional Outcomes between Bulbar Urethra and Bladder Neck Cuff Placement. J Urol. 2018;199:791–7.

    Article  PubMed  Google Scholar 

  17. Grimsby GM, Jacobs MA, Menon V, Schlomer BJ, Gargollo PC. Perioperative and Short-Term Outcomes of Robotic vs Open Bladder Neck Procedures for Neurogenic Incontinence. J Urol. 2016;195:1088–92.

    Article  PubMed  Google Scholar 

  18. Gargollo PC, Granberg C, Gong E, Tu D, Whittam B, Dajusta D. Complex Robotic Lower Urinary Tract Surgery in Patients with History of Open Surgery. J Urol. 2019;201:162–8. This article provides evidence supporting the feasibility of robot-assisted laparoscopic reconstructive surgery in patients who previously underwent laparotomy along with helpful tips.

    Article  PubMed  Google Scholar 

  19. Noordhoff TC, van den Hoek J, Yska MJ, Wolffenbuttel KP, Blok BFM, Scheepe JR. Long-term follow-up of bladder outlet procedures in children with neurogenic urinary incontinence. J Pediatr Urol. 2019;15:35.e1-35.e8.

    Article  CAS  PubMed  Google Scholar 

  20. Cull JN, Jacobson DL, Lau GA, et al. Internal hernia with volvulus after major abdominal reconstructions in pediatric urology - An infrequently reported and potentially devastating complication. J Pediatr Urol. 2023;19:402.e1-402.e7.

    Article  PubMed  Google Scholar 

  21. Lahlou M, Hukkinen M, Alova I, et al. Comparison of antegrade and retrograde endoscopic injection techniques for neurogenic sphincteric incontinence in children with neurogenic bladder. J Pediatr Urol. 2021;17:526.e1-526.e6.

    Article  PubMed  Google Scholar 

  22. Pakkasjarvi N, Taskinen S. Does intraoperative success predict outcome in the treatment of urethral sphincter insufficiency with bulking agent? J Pediatr Urol. 2018;14:173.e1-173.e5.

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this article.

Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Utah/Primary Children’s Hospital, 100 N. Mario Capecchi Drive, Suite 3550, Salt Lake City, UT, 84113, USA

    Deborah L. Jacobson & Glen A. Lau

Authors
  1. Deborah L. Jacobson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Glen A. Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both authors contributed equally to the literature review, manuscript drafting, and manuscript editing.

Corresponding author

Correspondence to Deborah L. Jacobson.

Ethics declarations

Competing Interests

The authors declare no competing interests.

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

Ethics approval and consent were not required for this review article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jacobson, D.L., Lau, G.A. Outcomes of Current Bladder Outlet Techniques for Neurogenic Bladder Dysfunction. Curr Bladder Dysfunct Rep 18, 333–345 (2023). https://doi.org/10.1007/s11884-023-00710-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-023-00710-w

Keywords

Search

Navigation