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Suprapubic catheter was inserted. Adjacent muscular and connective tissue was overlapped. Pubis
diastasis was approximated and monsplasty accomplished. Labia minora and bifid clitoris were
approximated medially, labia majora were rotated supero-medially and vulvo-introitoplasty was
accomplished.
RESULTS
Four FE girls, 15 months - 4 years aged, consecutively underwent the same procedure in the last
12 months. Surgery required 90-125 mins. Post-operative period was uneventful. The transurethral
catheter was removed at day 8
th
and the suprapubic at day 15
th
. At 3-9 months follow-up, cosmetic
appearance of external genitalia was almost normal and 3 girls experienced 2-3 hours day intervals
without significant urine residual. One girl presented stress urinary incontinence, progressively
reducing.
CONCLUSIONS
FE repair is often underestimated with disappointing results. Our procedure extends to FE the
principles of perineal reconstruction adopted for exstrophy, through a limited transpubic perineal
approach.
VS-20 (VS without presentation)
VESICOSCOPIC BLADDER NECK REPAIR IN NEUROGENIC
BLADDER INCONTINENCE
Alberto PARENTE
1
, Francisco Javier REED
2
, Raquel ROJO
3
, Ruben ORTIZ
3
,
Laura BURGOS
3
and Jose Maria ANGULO
3
1) GREGORIO MARAÑÓN UNIVERSITY HOSPITAL, PEDIATRIC SURGERY, Madrid, SPAIN - 2) Clínica Santa Maria,
Pediatric Urology, Santiago De Chile, CHILE - 3) Gregorio Marañon University Hospital, Pediatric Urology, Madrid,
SPAIN
PURPOSE
Over the years, many options for improving bladder outlet resistance in neurogenic bladder have
been described. Minimally invasive techniques are becoming more popular due to the difficult ac-
cess to this surgical area. We present the vesicoscopic technique for bladder neck plasty on the
anterior bladder wall.
MATERIAL AND METHODS
A 14 years-old patient with neurologic sphincter incontinence and previously failed of endoscopic
surgery was operated on. The surgery is done with the patient placed in the lithotomy position.
During cystoscopy, two 3-mm ports and one 5-mm port are inserted into the bladder under direct
transurethral vision. The bladder is insuf ated with CO2. A 12 Fr catheter is placed in the urethra
and percutaneously fixed to the anterior abdominal wall. A U-shaped incision is made around the
bladder neck with a monopolar cautery. The strip is tubularized with full-tickness suture and there-
fore the intravesical part of the urethra was enlonged approximately 2 cm.
RESULTS
Operation time was 151 minutes and postoperative hospital stay was 2 days. The intravesical
suprapubic drain was removed the 2
nd
postoperative day and the urethral catheter was removed
on 15
th
postoperative day. Transurethral clean intermittent catheterization was restarted without
complications. Patients are dry after 6 months.
CONCLUSIONS
Vesicoscopic bladder neck plasty is a relatively minor surgery with excellent cosmetic outcome and
quick recovery. More patients and more extensive follow-up is necessary for validation.