My presentation about wide bladder neck anomaly.

1. Wide Bladder Neck
Anomaly
Dr. Oğuz Kızılkaya
Trakya University Pediatric Surgery Clinic
oguz@fikrikumbara.com
*Bu sunumun hazırlanmasında slaytlarda belirtilen makalelerden yararlanılmıştır
* Sunum esnasında gösterilen hasta kayıtları için bilgilendirilmiş onam alınmıştır

3. Proximal hypospadias are a less common occurrence and correspond to 20% of total hypospadias. Proximal
hypospadias are usually associated with scrotal malformations, such as penoscrotal synaechia, hypoplasia, bifid
scrotum and high scrotum implantation.
The most commonly used classification of hypospadias is Barcat’s, and it is based on the location of the urethral
meatus after correction of the associated curvature of the penis. Proximal hypospadias include proximal penile,
penoscrotal, scrotal and perineal types in which the site of the urethral meatus is respectively the proximal third of
the penis, root of penis, scrotum or between the genital swellings and below the genital swellings.44

4. Techniques proposing neourethroplasty via a dermal graft, extending from the urethral meatus to the glans, date from
1836, when Dieffenbach, and, later, Duplay, with 2 lateral incisions brought together the edges of the urethral floor to
form a new urethra.
Smith, in 1973, modified Duplay’s technique proposing the coverage of the neourethra with a de-epithelialized skin
flap, thus considerably reducing the incidence of urethrocutaneous fistula.
Devine & Horton used a preputial skin graft after release of the fibrous chordee in a single procedure and reported
good results with one-stage repairs.
Hodgson and, later, Asopa & Asopa utilized the prepuce in the construction of the neourethra and to bridge the
cutaneous defect of the urethral ventrum.
Duckett suggested the use of a preputial island flap, where the preputial mucosa used to form the new urethra has
a well-individualized pedicle containing superficial dorsal penile vessels and, when dissected to a certain extent,
allows the neourethra to be advanced to the urethral plate without traction of the pedicle.

5. *Pediatric Urology, Gearhart, Rink,
Mouriquand

6. The stage-one repair includes an axial incision on the glans, which is completed by a ventral
dissection; then a full-thickness graft of preputial skin or buccal mucosa is harvested, sutured in place,
and immobilized with a “tieover” pressure dressing.
Six months after the first operation, the stage-two repair is the tubularization of the urethral plate.

7. URINARY INCONTINENCE

8. • What is the expected bladder capacity (EBC) ?
1-12 yr : (Age +1 ) * 30 (ml )
<1 yr : Weight in the kg * 7 (ml)
Post void RU > 20 significant
FVC show maximum void volume = 60-150 % of EBC
• What is the normal bladder control ?
Neonates : sacral spinal cord reflex voiding.
Infants:primitive reflexes are suppressed ,bladder capacity increases,and
voiding frequency is reduced
2-4 years :devolopment of conscious bladder sensation and voluntary
control .
*Dr. Edmond Wong ders slaytları

9. • What is the aetiology of urinary incontinence ?
95% functional cause
• Urge incontinence,voiding postponement , dysfunctional voiding,stress
incontinence ,giggle incontinence and associated with constipation
5% organic cause
• Ectopic ureter or neurogenıc bladder.
*Dr. Edmond Wong ders slaytları

10. Childhood urinary
incontinence
Nocturnal Diurnal
FunctionalNeuropathic
Structural
Functional
Obstructive
Figure 1. Simple classification of childhood urinary incontinence.
*Dr. Edmond Wong ders slaytları

11. Organic causes of chilhood urinary incontinence
 Urinary infection (Intermıttent leakage )
 Neuropathic (Continuous /Intermıttent leakage )
 Bladder outflow obstructıon (Intermıttent leakage )
 Structural (Continuous leakage )
 Exstrophy/epispadias
 Ureteric ectopia (girls)
 Congenital short urethra(girls)
 Urovaginal confluence (girls)
*Dr. Edmond Wong ders slaytları

16. BLADDER OUTLET SURGERY

24. PATIENT E.A
AGE 12, M
HISTORY OF PENOSCROTAL HYPOSPADIAS CORRECTION
URINARY INCONTINENCE
ACCESORY SCROTUM

25. History
• 12/2005: Bifid scrotum, accesory scrotum, micropenis, incomplet
masculanization. Hormonal panel = Normal, testosteron response
positive after BHCG, 5 alpha reductase deficiency? Partial androgen
insensitivity? Male pseudohermaphroditism?
• 01/2006: Hypospadias surgery
• 02/2007: Midpenil hypospadias reoperation
• 03/2008: Scrotal reconstruction, penile shaft correction
• 05/2016: Bracka operation

28. GÖRÜNTÜLEMELER