Leadbetter Bladder Neck Reconstruction

The external urethra is open to the dorsal side of the penis, and the distal mucosa of the urethra is cleft and is called a sulcus. It is a rare congenital malformation of the genitourinary organs. The cause of the disease is not clear, and may be related to the abnormal development of the cloaca at the 4th to 10th week of the embryo. The incidence is about 1 in 3 million, and men are four times more than women. The male surgical plan for urethral fissure is mainly based on: 1 urethral opening position; 2 degree of corpus cavernosum separation and its relationship with urethra; 3 with or without urinary incontinence; 4 with or without pubic bone separation; 5 with or without abdominal wall Defects, etc. Male urethral splitting is usually divided into three types according to the position of the urethra opening: 1. Penis head type: the outer urethra is open on the dorsal side of the penile sulcus, and the penis head is flat and flat, and generally there is no urinary incontinence. 2. Penis type: the urethra is open on the dorsal side of the penis body, the penis is flat and shovel-like, and it is deformed in the upper part, and some are accompanied by urinary incontinence of different degrees. 3. The pubic symphysis type: also known as complete urethral fissure. The external urethra is located below the pubic symphysis, the urethra of the penis is completely open, the penis is flat and deformed, and the urethral opening is wide. This type of bladder neck muscle dysplasia causes urinary incontinence. A small number of complete urethral fissures and bladder valgus coexist, called the complex bladder valgus-exospadias complex with pubic symphysis separation. Zhang Fengxiang has proposed a classification method for treatment purposes, which is divided into: 1 incomplete type (penis head and penis type), penis straightening; 2 complete type, penile elongation and anti-urinary incontinence surgery; Complex (with bladder valgus), penile elongation and anti-urinary incontinence surgery and repair of bladder valgus and abdominal wall defects. Any type of male urethral fissure requires surgery. The age of surgery is 4 to 5 years old, the age is too small, and the effect of anti-urinary incontinence is poor. Surgical correction should achieve the following purposes: 1 correct urinary incontinence; 2 restore normal urethral urination; 3 maintain normal sexual intercourse ability. Surgery indications against urinary incontinence should not be too strict, because the bladder neck and posterior urethra reconstruction in addition to anti-urinary incontinence, there is still anti-reverse ejaculation. A strict plan should be established before the urethral fissure, and it should be repaired in stages or in one stage. The urethral fissure without urinary incontinence can be considered for correction of penile malformation and urethroplasty. The urethral fissure with urinary incontinence is suitable for staged surgery. The first stage of bladder neck and posterior urethra reconstruction and penile extension at the same time Straightening surgery, the second phase of penile urethroplasty, can improve the success rate of surgery. For patients with stunted penis, testosterone or HCG can be given before surgery to promote their development. Bladder neck and posterior urethral reconstruction are the main means of treating urinary incontinence, and there are many methods. The use of a sphincter duct to replace the damaged or non-existent sphincter structure with the bladder wall or the triangular region of the proximal bladder neck is more effective. This is because the muscles contained in this segment of the bladder wall and the triangular region are essentially the same as the muscles of the normal urethral sphincter, and thus the structure of the valve is actually a mechanism for reconstructing the normal urethral sphincter. Preoperative cystoscopy and urodynamics are helpful in determining urinary incontinence. Cystoscopy can be used to understand the bladder neck and posterior urethra, and the surgical procedure is selected accordingly. Bladder neck and posterior urethral reconstruction should generally be performed after the age of 3, which is due to the phenomenon of natural enuresis before the age of 3, it is difficult to determine the degree of urinary incontinence to guide treatment. After 3 years of age, only those with incomplete urinary incontinence should undergo pelvic floor muscle training and urination training. If the effect is not significant, consider this surgery. Leadbetter bladder neck reconstruction is a classic procedure for constructing new bladder neck and posterior urethra using the triangular region of the bladder. It is more complicated than Young-Dees, but the bladder neck and posterior urethra are stronger than Young-Dees. Treatment of diseases: upper urethra Indication Leadbetter bladder neck reconstruction is suitable for upper urethral fissure with urinary incontinence; or incomplete urinary incontinence after training pelvic floor muscles and training ineffective after urination. Surgical procedure 1. Incision: The midline incision of the lower abdomen reveals the anterior wall of the bladder. The free bladder neck and posterior urethra are completely free of the bladder neck, the anterior wall and the lateral wall of the posterior urethra in the posterior pubic space, and directly reach the urogenital ridge. 2. Transurethral port transplantation: The anterior wall of the bladder is longitudinally incised, and the double ureteral orifice is transplanted above the bladder triangle according to a conventional method. 3. Cut the bladder neck and posterior urethra: cut the anterior wall of the urethra longitudinally along the incision of the bladder, try to free the posterior urethra, and then make 2 longitudinal incisions on both sides, from the side wall of the posterior urethra, through the side wall of the bladder neck At the end of the original ureteral orifice, a smooth muscle strip is formed on the posterior wall of the triangle, the bladder neck and the posterior urethra. 4. Posterior urethral formation of the bladder neck: The smooth muscle strip wraps around the 12-14F catheter, and sutures the mucosa of the muscle strip with a 5-0 absorbable line. The muscle layers are then staggered and overlapped with a No. 1 silk thread to form a anterior wall-reinforced myotube. 5. Suprapubic bladder stoma and closure of the incision: suture the bladder with a 2-0 absorbable line, and place the bladder stoma and the retropubic rubber tube for drainage. Close the incision layer by layer.