V08-05: The Anatomic Bladder Neck Tailoring in CPRE: The path to normal anatomy

Dana Weiss*, Philadelphia, PA, Elizabeth Roth, Travis Groth, John Kryger, Milwaukee, WI, Richard Lee, Boston, MA, Aseem Shukla, Philadelphia, PA, Joseph G, Boston, MA, Michael Mitchell, Milwaukee, WI, Douglas Canning, Philadelphia, PA

Introduction: The goals of the complete primary repair of bladder exstrophy include the anatomic closure of the bladder, bladder neck and urethra.  During this reconstruction, the bladder, bladder neck and urethral complex are placed into the deep pelvis to allow for optimal function and successful closure.

Methods: Over time, the bladder neck reconstruction has evolved with the identification of the continence zone – the area between the verumontanum and the midpoint of the bladder neck in males, and between the anterior edge of the vaginal orifice and the midpoint of the bladder neck in females.  The bladder neck reconstruction involves careful measurements and then tailoring of the proximal urethra, which allows for gentle outlet resistance without outlet obstruction.

Results: Among all bladder phenotypes, the anatomy of the bladder neck area is consistent.  The length of the verumontanum to the bladder neck is equivalent to the length from the vaginal orifice to the bladder neck. The distance of this continence zone has been consistently between 1-1.5cm in both males and females.  Starting a gradual taper from the verumontanum to the bladder neck allows for a natural, funneled shape once healed.

Conclusions: Through attention to detail and constant re-evaluation of game film, we have identified a consistent section of the proximal urethra and bladder neck that we believe is the continence zone.  This section is readily identifiable based on fixed landmarks in the urethra, at the verumontanum or anterior vaginal opening, and the midpoint of bladder neck striations.

Source of Funding: None