Bladder Neck Closure

Abstract

Bladder neck closure (BNC) is a procedure that, although not performed frequently, can be very beneficial for an appropriately selected patient. T he t raditional role of BNC w as in the female patient with a neurogenic bladder, destroyed bladder neck, and patulous urethra from longterm indwelling catheter drainage (1–4). Other options for urethral reconstruction using vagina or bowel have been reported, but are very complex, and attempts to create a patent and continent outlet are often unsuccessful (5). Other indications for the procedure have included bladder neck destruction from pelvic trauma, labor and delivery complications, and multiple failed surgical interventions to treat incontinence or urethrovaginal fistulas (6). Bladder neck closure can be combined with other procedures such as creation of a continent catheterizable stoma both separately or in combination with augmentation cystoplasty for patients with small capacity bladders or refractory detrusor overactivity (6–8). If the patient is unwilling or unable to perform intermittent catheterization, urinary drainage can be managed with a suprapubic tube or an ileovesicostomy (9). In early reports, BNC was often unsuccessful, but refinements in patient selection and surgical technique have significantly improved patient outcomes (13).