0022-534 7/78/1201-0040$02. 00/0
Vol. 120, July Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1978 by The Williams & Wilkins Co.
CLOSURE OF THE BLADDER NECK IN PATIENTS UNDERGOING CONTINENT VESICOSTOMY FOR URINARY INCONTINENCE R. REID, K. SCHNEIDER
AND
B. FRUCHTMAN
From the Department of Urology, Albert Einstein College of Medicine, Bronx, New Yark
ABSTRACT
The continent vesicostomy has been done on 24 patients, 10 of whom had severe urinary incontinence requiring closure of the bladder neck or urethra as well. Therefore, the bladder was converted to a closed cavity and intermittent catheterization is done through an abdominal stoma. No dressings or appliances are necessary. Bladder neck (or urethral) closure was successful in 8 of the 10 patients. One of the failures had been incontinent and was rendered continent on attempted bladder neck closure and there is urethral leakage at night in the other patient. Intermittent catheterization through a vesicostomy stoma has been cleaner and more aesthetically pleasing to the patients. The bladder neck closure has resulted in a dry perineum with fewer skin problems. In 1974 we described a new operation, which we called the continent vesicostomy. 1 Basically, the procedure involved the formation of a lower abdominal stoma of a viable flap of bladder, which was created in such a manner that there was no urinary leakage and, therefore, no need for dressings or appliances. Intermittent catheterization is done through the vesicostomy stoma. The continent vesicostomy has been done on 24 patients with neurogenic bladders. All of the patients had failed to achieve a catheter-free state by the conventional means and all had been considered for supravesical diversion. The basic problem with these 24 patients consisted of intractable incontinence or retention of urine. In those patients with urinary incontinence it was necessary to close the bladder neck or
EXPERIMENTAL WORK
Several techniques were attempted for closure of the bladder neck in the female mongrel dog. All dogs had undergone a continent vesicostomy operation. Simple ligature. A simple ligature with heavy silk on the outer aspect of the bladder neck was attempted in 6 dogs. In all instances there was persistent leakage of urine owing to recanalization. Ligature over a synthetic mesh. Heavy silk sutures and umbilical tapes were tied over a synthetic mesh placed around the bladder neck of the dog, again without success. Division of the bladder neck and urethra junction. Division with invagination of the severed ends did not achieve closure and resulted in vesicoureteral reflux.
Fm. l. Surgical technique to close bladder neck. A, dissection and excision of cuff of mucosa at bladder neck. B, apposition of denuded bladder neck with concentric absorbable sutures.
urethra in addition to the continent vesicostomy operation. This report concerns the experimental work and clinical experience with 2 methods to treat the incontinence problem in these patients. Accepted for publication July 15, 1977. Read at annual meeting of American Urological Association, Chicago, Illinois, April 24-28, 1977.
40
Gradual occlusion. Gradual occlusion of the bladder neck with metal ring and casein center was equally unsuccessful in achieving closure. Successful method of bladder neck closure. The experimental technique that gave satisfactory results was denudation of the bladder neck and apposition of tissue with concentric absorbable sutures (fig. 1). A septum of bladder mucosa grows
I
C
CLOtnJRE OF BLA.DDER J:'
Vol. 120, July Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1978 by The Williams & Wilkins Co.
CLOSURE OF THE BLADDER NECK IN PATIENTS UNDERGOING CONTINENT VESICOSTOMY FOR URINARY INCONTINENCE R. REID, K. SCHNEIDER
AND
B. FRUCHTMAN
From the Department of Urology, Albert Einstein College of Medicine, Bronx, New Yark
ABSTRACT
The continent vesicostomy has been done on 24 patients, 10 of whom had severe urinary incontinence requiring closure of the bladder neck or urethra as well. Therefore, the bladder was converted to a closed cavity and intermittent catheterization is done through an abdominal stoma. No dressings or appliances are necessary. Bladder neck (or urethral) closure was successful in 8 of the 10 patients. One of the failures had been incontinent and was rendered continent on attempted bladder neck closure and there is urethral leakage at night in the other patient. Intermittent catheterization through a vesicostomy stoma has been cleaner and more aesthetically pleasing to the patients. The bladder neck closure has resulted in a dry perineum with fewer skin problems. In 1974 we described a new operation, which we called the continent vesicostomy. 1 Basically, the procedure involved the formation of a lower abdominal stoma of a viable flap of bladder, which was created in such a manner that there was no urinary leakage and, therefore, no need for dressings or appliances. Intermittent catheterization is done through the vesicostomy stoma. The continent vesicostomy has been done on 24 patients with neurogenic bladders. All of the patients had failed to achieve a catheter-free state by the conventional means and all had been considered for supravesical diversion. The basic problem with these 24 patients consisted of intractable incontinence or retention of urine. In those patients with urinary incontinence it was necessary to close the bladder neck or
EXPERIMENTAL WORK
Several techniques were attempted for closure of the bladder neck in the female mongrel dog. All dogs had undergone a continent vesicostomy operation. Simple ligature. A simple ligature with heavy silk on the outer aspect of the bladder neck was attempted in 6 dogs. In all instances there was persistent leakage of urine owing to recanalization. Ligature over a synthetic mesh. Heavy silk sutures and umbilical tapes were tied over a synthetic mesh placed around the bladder neck of the dog, again without success. Division of the bladder neck and urethra junction. Division with invagination of the severed ends did not achieve closure and resulted in vesicoureteral reflux.
Fm. l. Surgical technique to close bladder neck. A, dissection and excision of cuff of mucosa at bladder neck. B, apposition of denuded bladder neck with concentric absorbable sutures.
urethra in addition to the continent vesicostomy operation. This report concerns the experimental work and clinical experience with 2 methods to treat the incontinence problem in these patients. Accepted for publication July 15, 1977. Read at annual meeting of American Urological Association, Chicago, Illinois, April 24-28, 1977.
40
Gradual occlusion. Gradual occlusion of the bladder neck with metal ring and casein center was equally unsuccessful in achieving closure. Successful method of bladder neck closure. The experimental technique that gave satisfactory results was denudation of the bladder neck and apposition of tissue with concentric absorbable sutures (fig. 1). A septum of bladder mucosa grows
I
C
CLOtnJRE OF BLA.DDER J:'
