Improved results using a modification of the Young-Dees-Leadbetter bladder neck repair.

Forty-seven patients with primary total incontinence underwent bladder neck reconstruction (BNR) between 1978 and 1988. This included 31 patients with exstrophy/epispadias, 14 with myelomeningocele and 2 with caecoureteroceles. The patients were divided into 5 groups based on the type of BNR: Group 1--standard Young-Dees-Leadbetter (YDL) BNR; Group 2--YDL+Silastic sheath; Group 3--modified YDL; Group 4--Kropp BNR; Group 5--other BNRs. Group 1 included 18 patients with a 45% primary continence failure rate, a 44% reoperation rate and only a fair ability to void spontaneously after BNR. There were 11 patients in Group 3 with a 9% primary continence failure rate, a 27% reoperation rate and excellent post-operative emptying. None of the 3 patients in Group 4 was incontinent post-operatively, but they all required reoperation and had poor post-operative emptying. We feel that the modified YDL BNR provides better overall voiding and continence with less morbidity than the other bladder neck/urethral reconstructive procedures.