Transvaginal closure of the bladder neck

Abstract

Transvaginal closure of the bladder neck represents an uncommon surgical procedure, as its main indication is in patients who have urethral destruction secondary to prolonged catheter drainage of a neurogenic bladder. 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 urethral destruction, results 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. © 2006 Humana Press Inc.