940 TRANS-VAGINAL BLADDER NECK CLOSURE WITH POSTERIOR URETHRAL FLAP

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010940 TRANS-VAGINAL BLADDER NECK CLOSURE WITH POSTERIOR URETHRAL FLAP Colin Goudelocke, Brett Lebed, J. Nathaniel Hamilton, and Eric Rovner Colin GoudelockeColin Goudelocke Charleston, SC More articles by this author , Brett LebedBrett Lebed Philadelphia, PA More articles by this author , J. Nathaniel HamiltonJ. Nathaniel Hamilton Charleston, SC More articles by this author , and Eric RovnerEric Rovner Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1819AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral and bladder neck destruction due to chronic indwelling urethral catheters in female neurogenic patients is a devastating complication. Transabdominal bladder neck closure carries significant morbidity, while traditional transvaginal bladder neck closure can be associated with ureteric injury and fistula formation. We present a variation on the traditional trans-vaginal bladder neck closure technique using a posterior urethral flap that minimizes the potential risk of ureteric injury and fistula formation. METHODS A wide-based anterior vaginal wall inverted “u” shaped flap is developed from the urethral meatus to beyond the bladder neck. After circumscribing the urethral meatus, a dorsal semi-lunar incision is made above the urethra and dissection is carried above the urethra beneath the symphysis pubis into the retropubic space, taking down the pubourethral and urethropelvic ligaments mobilizing the urethra and anterior bladder neck. The dorsal urethra is bivalved and the incision is carried onto the anterior bladder for a distance of 2-3 cm. The opened ventral urethra is then rotated cephalad over the anterior bladder wall and the closure is secured to the posterior symphysis pubis high in the retropubic space. The vaginal wall is closed as a 2nd layer. RESULTS 9 consecutive female neurogenic patients underwent transvaginal bladder neck closure as described with placement of a suprapubic tube. Mean blood loss was 268cc. There were no intra-operative or acute post-operative complications, with a mean hospital stay of 1.6 days. Post-operative cystograms at 3 weeks were negative for leak but one patient developed wound breakdown due to medical comorbidities at 1 month requiring a 2nd procedure. Mean follow up was 11.6 months (range 1 to 36). Serial ultrasound at the time of last follow-up revealed no new hydroureteronephrosis or ureteral obstruction. CONCLUSIONS Transvaginal bladder neck closure with posterior urethral flap is a simplified technique of bladder neck closure with satisfactory early outcomes. We feel that the use of the urethra as a flap maintains the bladder neck closure safely away from the ureteric orifices minimizing the risk of upper tract injury. The rotation of the posterior urethra onto the anterior bladder wall secures the suture line high into the retropubic space decreasing the risk of fistula formation. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e366-e367 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Colin Goudelocke Charleston, SC More articles by this author Brett Lebed Philadelphia, PA More articles by this author J. Nathaniel Hamilton Charleston, SC More articles by this author Eric Rovner Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...