Introduction: Bladder neck closure (BNC) is a salvage option for patients with intractable urinary incontinence, irreparable urethral erosion or stricture disease. The widely established abdominal approach is very invasive. Since patients receiving a BNC are mostly elderly and of poor performance status, as less invasive approach would be beneficial. Therefore, we performed a perineal urethral closure. The aim of this study was to retrospectively assess continence and complication rates of perineal urethral closures.
Methods: Urethral closure was performed through a perineal approach. After preparation of the urethra the dissection of the urethra was performed on the level of the pelvic floor in the membranous part of the urethra. After urethral closure the proximal part is covered by a bulbospongiosus muscle flap or a fat flap. Postoperatively, the bladder was continuously drained via suprapubic catheter for 3 weeks. Then a cystography was performed. In case of no extravasation patients were counseled to perform ISK or ventil usage for suprapubic catheter. We identified patients who were treated with this approach in our patient records and baseline characteristics, especially concerning continence status and ICIQ-SF, were assed. We performed a follow-up (FU) of those patients using an interview and ICIQ-SF to analyse success rates and complications.
Results: We identified a total of 21 patients in our records and 18 (85.7%) of those were available for FU and further analysis. Median FU was 41 months (IQR 20.5-54.25). Cause of incontinence was RRP in 12 patients (66,7%), TUR in 5 patients (27,8%) and trauma in 1 patient (5,6%) respectively. A total of 9 patients (50%) showed a history of previous incontinence surgery and 14 patients (77.8%) showed a history of previous pelvic radiation therapy respectively. Urinary diversion was performed via Mitrofanoff stoma in 5 patients (27.8%) and via suprapubic catheter in 13 patients (72.8%). Cystoplasty with ileumaugmentation was performed in 2 of the patients with Mitrofanoff stoma. The median pad usage per day before urethral closure was 7 (3.75-10 IQR). After one procedure 13 patients (72.2%) acquired continence. 5 patients (27.8%) required surgical revisions. Four of those 5 patients had a history of radiation (Rx) and one had an uncommon cause of his incontinence (trauma). Overall 16 patients (88.9%) showed good satisfaction concerning QuoL (0-2 Points). Medium pads per day were 0 (Range 0-6). No pad Rate was 16/18 (88.9%).
Conclusions: Perineal urethral closure shows good results concerning patients satisfaction and no pad rate. Failure can be treated with a redo of the procedure. Failures only occurred in patients with a history of Rx or uncommon cause of their incontinence. Therefore, the perineal urethral closure can be discussed as a less invasive alternative approach for abdominal BNC and should be considered for multimorbid patients. Source of