Detrusor Wrap-Around Bladder Neck (DRBN) for Treatment of Urinary Incontinence Following Exstrophy Closure

Abstract

Purpose The use of a demucosalized detrusor pedicle flap as a bladder neck wrap was described by Mitchell. The outcome of this novel technique of bladder neck reconstruction (BNR) in 28 children with bladder exstrophy is presented. Material and Methods The records of all patients who underwent bladder neck reconstruction using DWBN were reviewed. A total of 28 patients were identified and included 21 boys and 7 girls with mean age at surgery of 8.3 years. All patients had previous exstrophy closure (17 staged & 11 complete). Eight patients (29%) had previous endoscopic injection of bulking agent at the bladder neck. At time of surgery 13 patients (46%) required concomitant augmentation ilepcystoplasty and continent catheterizable outlet. Ureteral reimplantation was not performed in any patient. Continence was defined as complete dryness for a minimum of 4 hours. Results Mean follow-up duration is 31 months (range 13-48). All augmented patients were on CIC through the continent outlet. Complete dryness was achieved in 20/28 patients (71%). However, continence rate was only 47% in the non augmented group compared to 100% in the augmented group. Six of the incontinent children underwent bladder neck injection using bulking agent but dryness was achieved only in 1 (17%). Conclusions DWBN is a viable option for bladder neck reconstruction for incontinent children after exstrophy closure. However, bladder augmentation and continent outlet construction are the pillars of optimal success. Injection of bulking agent at the bladder neck for failures has poor success.