Young-Dees bladder neck reconstruction: An effective alternative in the treatment of urinary incontinence following urethroplasty for pelvic fracture urethral injury

Abstract

Introduction: We review our experience of Young-Dees bladder neck reconstruction (BNR) in treatment of urinary incontinence following anastomotic urethroplasty for pelvic fracture urethral injury (PFUI). Material and methods: Between January 2009 and June 2015, 11 patients presented with urinary incontinence following urethroplasty for PFUI. After evaluation with voiding cystourethrogram, urodynamics and cystoscopy, seven were found to be having genuine stress urinary incontinence. All seven underwent Young-Dees BNR. We also looked at whether there were any predictors of either poor or good outcome following surgical correction based on radiographic, endoscopic and urodynamic findings. Results: Of the seven patients who had undergone Young-Dees BNR, four had urethroplasty at our centre (4/89, 4.4%). Median age was 23 years (range = 14–31 years), and median time to definitive treatment was 15 months (range = 9–126 months). Age at injury <15 years in two and >15 years in five. Four (56%) had pubic diastases, in three, it was secondary to the injury, and in one, it was consequent to facilitating urethroplasty via a formal transpubic approach. There were no consistent radiographic findings on the pre-operative studies which could predict whether the configuration of the bladder neck or the degree of bladder descent might result in incontinence. The number of prior attempts at urethroplasty when compared to a similar cohort was also non-contributory. At urodynamics, all bladders were stable on filling and there were no issues related to compliance with the bladder neck being occluded. The detrusor pressure generated during voiding and with the bladder neck occluded did help us to counsel patients regarding the outcome of surgery and if there would be a need for clean intermittent self-catheterisation following surgery. All patients are voiding via naturalis without the need for clean intermittent self-catheterisation and are socially continent. Conclusion: Young-Dees BNR may be a forgotten procedure but is worth revisiting in patients with stress urinary incontinence following successful urethroplasty for PFUI. It is cost-effective and can be done without the Leadbetter modification. Level of evidence: Not applicable