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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence. 67 3

We performed the transvaginal approach described by S. Raz for stress urinary incontinence and cystocele. 13 patients with cystocele and stress urinary incontinence underwent the four corner Bladder neck suspension 12 patients with stress urinary incontinence alone underwent simple bladder neck suspension. After a median follow-up of 4,1 months 92% were cured of incontinence. Cystoceles grade II and III were completely reduced. These results are comparable with abdominal approach for less morbidity and shorter hospital stay.
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PMID:[S. Raz' method of bladder suspension and treatment of cystocele in urinary stress incontinence (short-term results)]. 141 35

Bladder neck resection or incision in the female is not a new urologic procedure; however, it has not been widely accepted because of poor results and complications. From January to December, 1986, ten such operations have been performed on females with obstructive uropathy. All had previous anti-incontinence procedures and postoperative obstruction developed. Bladder neck incisions rather than resections have been performed with encouraging results. Urologic presentation, urodynamic investigations, and details of the surgery are presented. Bladder neck incision is a valuable adjunct in the management of bladder neck obstruction in the female.
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PMID:Female bladder neck incision. 230 31

Bladder dysfunction is a recognized complication following radical hysterectomy, however, the effect of radiation alone or in combination with surgery on bladder function has received little attention. Thirty patients who underwent radical hysterectomy with postoperative whole pelvis radiation (RH + RT) were matched for age, stage of disease, and time interval since therapy, with 30 patients who had radical hysterectomy alone (RH) and 30 patients who were treated with pelvic radiotherapy (RT). Bladder function was assessed by symptoms and urodynamic evaluation. Altered bladder sensation and voiding problems were associated with surgery, and were more frequent after RH or RH + RT than RT (P = 0.002). fifty percent of RH patients voided by abdominal straining compared to 10% who had only RT. No greater problem was seen after RH + RT compared to RH. Urinary incontinence was present in 15% of patients prior to therapy. After treatment, incontinence requiring protection developed in 23% of RT patients, 26% of RH patients, and 63% of RH + RT patients. The severity of the incontinence was greater after RH + RT. Bladder neck and urethral function was similar in all groups, however, bladder compliance was reduced in RT patients and significantly (P = 0.0001) reduced after RH + RT compared to RH alone. This reduction was related to the bladder dose of external radiation and was a factor in the etiology of the urinary incontinence seen in RH + RT patients.
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PMID:The adverse effects of cervical cancer treatment on bladder function. 357 46

Nineteen women with detrusor hyperreflexia were investigated urodynamically before and 3 months after bladder neck resection. In the case of the first 10 patients bladder neck anesthesia was performed before resection. In only 2 patients urodynamic reactions to anesthesia and to resection were similar and related to the effect of the resection. In 11 patients bladder neck resection improved voiding symptoms and a significant reduction in the urinary incontinence was found. Bladder neck resection was followed by a significant increase in the effective bladder volume and the bladder volume at first detrusor hyperreflexia. An insignificant reduction in the residual urine of 13% was observed after bladder neck resection but the distance to maximal urethral closure pressure and the area of the functional part of the urethral pressure profile was significantly reduced.
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PMID:Bladder neck anesthesia and resection in women with detrusor hyperreflexia. 361 56

Bladder neck reconstruction using an anterior bladder flap was used in 10 patients with total diurnal urinary incontinence, persistent 1 year after suprapubic (n = 6) or transurethral (n = 4) prostatectomy. 8 patients achieved symptomatic improvement, 6 of them with excellent or good results. Bladder neck reconstruction is undoubtedly able to correct post-prostatectomy incontinence, provided there is no residual bladder neck obstruction or alteration of the bladder musculature due to previous surgery. These cases should be considered for artificial sphincter implantation.
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PMID:Bladder neck reconstruction using an anterior bladder flap in post-prostatectomy incontinence. 402 29

Total urinary incontinence developed secondary to incompetence of the urethral closing mechanism in 8 spinal cord injury patients who were on Foley catheter drainage (5 patients) or suprapubic cystostomy (3 patients). All patients had irreparable urethrocutaneous fistulas and 4 had urethroperineal erosion. Closure of the bladder neck with drainage via a suprapubic cystostomy tube was used to divert the urinary stream. Bladder neck closure was successful in alleviating total urethral urinary incontinence in all patients. However, suprapubic abdominal leakage developed in 2 patients. This procedure should be recommended cautiously when a maximal bladder capacity greater than 125 cc cannot be maintained unless concomitant augmentation cystoplasty also is considered.
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PMID:Closure of the bladder neck in spinal cord injury patients with urethral sphincteric incompetence and irreparable urethral pathological conditions. 672 9

On August 23, 1982 a 24-year-old woman presented with incontinence following her first delivery. From infancy she used to void urine frequently. When she was 4 years old a left nonfunctioning kidney was diagnosed and left nephrectomy was done. The external genitalia were remarkable in that there was a solitary orifice in the vestibule. The other items in the examination were normal. Vaginal examination revealed that the urethral meatus was on the anterior vaginal wall about 3 cm proximal to its orifice. Bladder neck and proximal urethral narrowing combined with suspension of bladder neck was performed on January 19, 1983. Postoperative course was uneventful and she was continent when the bladder was filled up to 200 ml while she stood erect. Our case might belong to group 3 according to Blum 's classification.
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PMID:[A case of hypospadias in a woman whose incontinence was repaired surgically]. 673 Nov 92

Bladder neck closure is not a standard part of continent urinary diversion. When bladder augmentation and continent urinary diversion are done simultaneously, it is frequently convenient and advantageous to leave the native bladder neck intact as long as there is a reasonable degree of intrinsic continence. Even in patients with marginal control the effect of lowering intravesical pressure and increasing intravesical volume will often produce acceptable continence. At times, particularly in patients who have undergone multiple surgical procedures involving the bladder neck, there is poor intrinsic resistance. To provide acceptable continence in these cases bladder neck closure is a necessary part of continent diversion. Between 1990 and 1993 we treated 6 male and 7 female patients, most of whom underwent simultaneous bladder augmentation and continent urinary diversion, and they had poor intrinsic outlet resistance. Patient age ranged from 8 to 22 years. Underlying diagnoses included thoracic myelomeningocele in 5 patients, bladder exstrophy in 5, bladder leiomyosarcoma in 1 and extensive pelvic trauma in 1 as well as 1 previously separated conjoined twin. Three patients had artificial urinary sphincter failure and 3 had failure of urethral sling procedures. A clean intermittent catheterization program had failed in 12 patients and all 13 had diurnal incontinence. Bladder neck and urethral resistance was evaluated using voiding cystourethrography and urodynamics to measure leak point pressure and bladder capacity. Reliable bladder neck closure is historically difficult to achieve and is best done at the time of diversion. We have had initial success in 12 of our 13 cases and subsequently in all 13 using a technique of bladder neck division, 2-layer closure and omental interposition between the bladder neck closure and urethra.
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PMID:Bladder neck closure in association with continent urinary diversion. 760 4

In a 7-year period 28 patients 1 to 20 years old have undergone bladder neck closure in conjunction with Mitrofanoff diversion for the management of severe incontinence. Surgery was performed as a salvage procedure in 19 patients and as a primary anti-incontinence procedure in 9. At a mean followup of 29 months 27 of 28 patients (96%) were totally continent, requiring no pads. Bladder neck closure was primarily successful in 24 of 28 patients (86%) and 25 (89%) had stable upper tracts. Five patients had bladder calculi and 5 required stomal revisions. One child had a bladder perforation associated with blunt trauma. Bladder neck closure and Mitrofanoff diversion were done without bladder augmentation in 11 cases and augmentation was performed previously or concurrently in the remainder. Four patients who did not initially undergo augmentation required later augmentation (2 for hydronephrosis and 2 for persistent incontinence). We conclude that bladder neck closure in conjunction with Mitrofanoff diversion is highly efficacious in achieving continence in a highly complex subgroup of patients with intractable urinary leakage. With careful patient selection and diligent followup total continence can be achieved in this most difficult patient population.
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PMID:Concomitant bladder neck closure and Mitrofanoff diversion for the management of intractable urinary incontinence. 760 5


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