PD06-04 THE SUB SYMPHYSEAL APPROACH TO THE BLADDER NECK FOR CHILDREN BORN WITH INCONTINENT EPISPADIAS

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD06-04 THE SUB SYMPHYSEAL APPROACH TO THE BLADDER NECK FOR CHILDREN BORN WITH INCONTINENT EPISPADIAS Moneer Hanna, Mohammed El Menshawy, and Ashraf Fahmy Moneer HannaMoneer Hanna More articles by this author , Mohammed El MenshawyMohammed El Menshawy More articles by this author , and Ashraf FahmyAshraf Fahmy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To review the outcome of a less invasive surgical approach for plication/ reconstruction of the bladder neck to treat urinary incontinence which may be combined with partial penile disassembly in boys born with epispadias. METHODS: Between 2010 and 2022 a total of 9 children, 6 boys born with penopubic epispadias and 3 girls with incontinent epispadias, all had no prior surgery were operated via the sub symphyseal approach. Their age varied between 3 and 11 years. In boys the urethral plate was first dissected and lifted from the corporal bodies down to the glans penis distally and the wide bladder neck proximally i.e partial penile disassembly. In girls the skin wedge between the crura of the clitoral bodies was raised and tabularized to be used for retraction and further proximal dissection behind the pubic symphysis. The urethra was tubularized over 10 French catheter 10 French catheter, and the bladder neck was plicated over the catheter in 6 children using non absorbable sutures. In 3 children (one boy and 2 girls) the bladder neck was too wide, and a triangular wedge of tissue was excised followed by 2-layer closure with long lasting absorbable sutures around the catheter. The bladder was filled with saline and the water tightness of the suture line and/or the competence of the plicated bladder neck were tested. The corporal bodies are rotated and sutured together to correct the dorsal chordee and the penis is resurfaced by skin. In girls the crural bodies are approximated followed by monsplasty. RESULTS: The follow up ranged between 6 months and 5 years. All boys and 2 girls who were incontinent achieved dryness for 3+ hours and achieved volitional voiding over 6 months postoperatively. One girl exhibited stress incontinence which improved considerably following periurethral injection of bulking agent. The bladder capacity increased from 50- 120 ml preoperatively to 150-230 ml. post-surgery with gradual increase of the bladder capacity over the years. 6/18 renal units showed vesicoureteral reflux (Grade II-III) prior to surgery and were all corrected successfully by endoscopic bulking agent injections. CONCLUSIONS: The sub symphyseal exposure to achieve continence by plicating and/or reconstructing the bladder neck provides a safe and effective surgical approach for children born with incontinent epispadias. Furthermore, in boys it can be combined with penile disassembly. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e156 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moneer Hanna More articles by this author Mohammed El Menshawy More articles by this author Ashraf Fahmy More articles by this author Expand All Advertisement PDF downloadLoading ...