Detrusor sling bladder neck closure – follow up results

Introduction

There are a number of procedures which aim to prevent urethral leakage of urine in patients with a neuropathic bladder performed in combination with reconstruction operations. We have previously reported our initial experience using a sling created from detrusor muscle¹. This presentation gives longer follow up results of the procedure.

Methods

The technique was described previously[1]. An incision is made in the anterior wall of bladder muscle and a detrusor flap is raised. This strip is wrapped around the upper urethral mucosa and sutured with 3/0 polygalactamin before closure of urethral muscle over strip.

Results

We have performed this procedure on 5 patients (2 males and 3 females) with a median age of 7 years 3 mo (range 5–17 yrs). The neuropathic bladder was secondary to pelvic tumour (n = 2), spina bifida, following treatment of Hirschsprung's disease and anorectal anomaly (n = 1 each). At a median follow-up of 4 years (range 3–5 years), 3 patients remain dry on intermittent catheterisation via their Mitrofanoff stomas and one is damp. One patient remained urethrally incontinent from early failure of the procedure on transfer to adult services. No patient has achieved urethral catheterisation.

Conclusion

Our results suggest that the detrusor sling bladder neck closure can achieve lasting continence with results comparable to bladder neck division. Urethral catheterisation following this procedure is unlikely to be achieved. In patients who have had previous surgery at the bladder neck this procedure is unlikely to be feasible.