Transvaginal Closure of Bladder Neck

Abstract

Transvaginal closure of the bladder neck in the female patient is indicated for those with a devastated outlet, usually caused by chronic indwelling urethral catheter placement. Many of these patients have a neurogenic etiology for either urinary retention or urinary incontinence. Chronic catheterization leads to urethral erosion and destruction, ultimately resulting in a patulous urethra that cannot be maintained in the bladder. Management is limited as many of these patients are debilitated due to their comorbid conditions. There is often an inadequate amount of residual urethra to allow for placement of a pubovaginal sling and many of these patients are unwilling or unable to undergo urinary tract reconstruction. Therefore, the best option is often bladder neck closure with suprapubic tube (SPT) placement. Transvaginal closure is an outstanding option that does not require an abdominal incision so is minimally invasive; however, vaginal techniques can be technically challenging for inexperienced vaginal surgeons. Primary complications include fistula formation, bladder stones, SPT site leakage or stenosis, and wound infection. Transvaginal closure of the bladder neck carries less morbidity but may require more than one procedure to achieve continence.