Current status of bladder neck reconstruction.

PURPOSE OF REVIEW: This paper reviews the literature over the last 3 years on bladder outlet procedures for children with urinary incontinence. The multitude of procedures and need for concomitant bladder augmentation indicates that there is no ideal surgical option for these children.

RECENT FINDINGS: The results of bladder neck slings with or without bladder augmentation have been reported in some key studies during this review period. Several modifications of the bladder wrap around sling and modifications of the Kropp-Salle procedure are described. Long-term results of bladder neck injections are highlighted. Preliminary results of complete primary repair of bladder exstrophy are compared with those of staged repair.

SUMMARY: Achieving urinary continence is difficult and continues to challenge the reconstructive surgeon. Standardized definition of dryness and further efforts to search for preoperative criteria to define the etiology of incontinence are needed to better assess outcomes.