Outcomes of Current Bladder Outlet Techniques for Neurogenic Bladder Dysfunction

Purpose of ReviewThis article evaluates the literature published from 2016 to 2023 regarding bladder outlet techniques for neurogenic bladder dysfunction in children.Recent FindingsContinence rates following open bladder neck reconstruction remain highly variable, ranging from 17 to 96% in recent series. Augmentation cystoplasty at the time of bladder neck reconstruction appears to improve both postoperative continence and bladder compliance in longer-term follow-up, with a large percentage of children undergoing isolated bladder neck procedures progressing to augmentation cystoplasty within a few years of reconstruction. Artificial urinary sphincter placement is safe and effective in children with neurogenic bladder but need for device replacement is inevitable. Catheterization through a continent catheterizable channel improves device longevity. Continence outcomes following management with primary bladder neck sling or bladder neck injection are poor, but slings and bladder neck injections paired with bladder neck reconstruction appear to improve continence outcomes. Robot-assisted interventions are safe, efficacious, and more time intensive than open procedures, though operative times improve with surgeon experience. Use of chemodervation agents at the time of bladder outlet procedures decreases postoperative opiate usage, and combined antegrade/retrograde bladder neck injections may improve procedure outcomes.SummaryFollowing a systematic literature review through the PubMed database, a total of seventeen relevant manuscripts were published from 2016 to 2023. This article provides an overview of the surgical considerations for bladder outlet procedures, a description of technical considerations for open and minimally invasive approaches, and a review of surgical outcomes using information gained from these studies.