1. The Young–Dees–Leadbetter–Jeffs bladder-neck reconstruction. A
The Young–Dees–Leadbetter–Jeffs bladder-neck reconstruction. A. After mobilization of the bladder neck and proximal urethra, a low transverse incision is extended vertically exposing the ureteral orifices and the entire trigone and proximal urethra. B. The bladder muscle lateral to the mucosal strip is denuded by sharp dissection. C. Ureteral reimplantation is performed using either a cross-trigonal technique or a cephalotrigonal technique to provide additional trigonal tissue for the repair. D. A strip of mucosa approximately 15 to 20 mm in width by 30 mm in length that extends from the midtrigone to the prostatic urethra is outlined. E, F. Multiple small incisions into the bladder muscle in the area of the denuded lateral triangles allow lengthening of the bladder neck area and allow the bladder to retract into a more cephalad position. G, H. The bladder neck is closed, beginning with a suture that incorporates detrusor muscle and urothelium. Each suture is placed on traction to draw up more of the strip to allow for easier subsequent placement of the more distal sutures. I. The completed mucosal layer of the repair. J. Ureteral stents, which will be left for 10 to 14 days, are placed and sutured. The first layer of the double-breasted bladder-neck plasty is placed. K. The second layer of horizontal mattress sutures is placed. L. The bladder is closed after placement of a suprapubic catheter, which will remain in place for 3 weeks. M. The outer layer of the vest-over-pants repair is brought anteriorly as a Marshall–Marchetti–Krantz bladder-neck suspension. (From Gearhart JP. Bladder neck reconstruction in the incontinent child. In: Frank J, Johnston JH, eds. Operative Paediatric Urology. Edinburgh: Churchill Livingstone; 1990:228–231. Used with permission.)
Source: Bladder Exstrophy, Operative Pediatric Surgery
Citation: Ziegler MM, Azizkhan RG, Allmen D, Weber TR. Operative Pediatric Surgery; 2014 Available at: Accessed: October 30, 2017
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