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Robotic-assisted bladder neck procedures in children with neurogenic bladder

  • Patricio C. Gargollo
  • Lindsay A. WhiteEmail author
Topic Paper
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Abstract

Purpose

To review the current status of robotic-assisted laparoscopic surgical techniques for bladder neck procedures in children with incontinence secondary to neurogenic bladder.

Methods

A comprehensive review of the literature on robotic-assisted bladder neck procedures was conducted, with a focus on articles published in the last 25 years. These data were subsequently compared to published series of open bladder neck procedures and published results from robotic-assisted bladder neck reconstruction series completed at our institution.

Results

The principle bladder neck procedures for incontinence in pediatric patients with neurogenic bladder include: Artificial Urinary Sphincter, Bladder Neck Sling, Bladder Neck Closure, and Bladder Neck Reconstruction. Continence rates range from 60 to 100% with a lack of expert consensus on the preferred procedure (or combination of procedures). Robotic-assisted approaches are associated with longer operative times, especially early in the surgical experience, but demonstrate equivalent continence rates with potential benefits including low interoperative blood loss, improved cosmesis, and decreased intra-abdominal adhesion formation.

Conclusions

Robotic-assisted procedures of the bladder neck are safe, feasible, follow the same steps and principles as those of open surgery and produce equivalent continence rates. Robotic-assisted techniques can be adapted to a variety of bladder neck procedures and safely expanded to selected patients with the previous open abdominal surgery.

Keywords

Neurogenic bladder Robotic-assisted surgery Bladder neck reconstruction Artificial urinary sphincter Bladder neck sling Bladder neck closure 

Abbreviations

APV

Appendicovesicostomy

AUS

Artificial Urinary Sphincter

BNC

Bladder Neck Closure

BNR

Bladder Neck Reconstruction

BNS

Bladder Neck Sling

CIC

Clean Intermittent Catheterization

LM

Leadbetter/Mitchell

PAS

Previous open abdominal surgery

RAL-AUS

Robotic-assisted laparoscopic artificial urinary sphincter

RALS

Robotic-assisted laparoscopic surgery

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Notes

Authors’ contributions

PCG: protocol/project development, data analysis, and manuscript editing. LAW: data collection, data analysis, and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric UrologyMayo Clinic and Mayo Medical SchoolRochesterUSA
  2. 2.Mayo Clinic and Mayo Clinic School of Graduate Medical EducationRochesterUSA

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