A technique for bladder neck reconstruction in exstrophy: the cinch.

A surgical modification of the Young-Dees-Leadbetter procedure for bladder neck reconstruction is presented. The procedure uses a bladder muscle flap devoid of mucosa as a cinch to encircle and compress the reconstructed neourethra, increasing urethral resistance and helping to achieve continence in patients with bladder exstrophy. The operation combines the continence enhancing features of bladder neck narrowing, urethral elongation, cuff compression, sling suspension of the urethra and urethropexy. Of 10 patients who underwent an operation 6 are dry during the day and night, and they achieved continence relatively soon postoperatively.