Transvaginal Closure of the Bladder

Transvaginal closure of the bladder neck represents an uncommon surgical procedure,because its main indication is in patients who have urethral destruction secondary to prolonged catheter drainage in a neurogenic bladder.3 The resultant effect of the catheter and Foley balloon on the urethra is erosion and pressure necrosis as well as spontaneous urethral extrusion from severe bladder spasms. The usual course of events is progressive worsening of leakage around the catheter, necessitating larger catheters and more fluid placement in the balloon. These sequential increases in catheter size along with the concomitant ure-thral destruction result in a wide, patulous, and severely damaged urethra. Accordingly, proper management of these patients requires transvaginal closure of the bladder neck and simultaneous urinary diversion with a continent catheterizable augmentation, incontinent ileovesicostomy, or suprapubic catheter. Typically, an obstructing sling or AUS will not be possible because of insufficient length of urethra for coaptation caused by erosion.

Most patients that would be candidates for transvaginal closure of the bladder neck are those who have a neuro-genic bladder and urethral destruction secondary to long-term catheter drainage. Other indications include refractory urethrovaginal fistula, severely shortened urethra, and severe refractory intrinsic sphincteric deficiency.

Figure 6-7.2. Synthetic sling in cross-sectional view after sling has been transferred suprapubically. (Reprinted with the permission of The Cleveland Clinic Foundation.)

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