Bladder Neck Closure in Conjunction with Enterocystoplasty and Mitrofanoff Diversion for Complex Incontinence: Closing the Door for Good
Why this work is in the frame
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Bibliographic record
Abstract
PURPOSE: Bladder neck closure is an irreversible procedure requiring compliance with catheterization of a cutaneous stoma and historically has been reserved for the definitive treatment of intractable incontinence after prior failed procedures. We assessed long-term outcomes of our patients undergoing bladder neck closure including continence status, additional surgical interventions, postoperative complications, conception and sexual function, and satisfaction with bladder neck closure. MATERIALS AND METHODS: We performed a retrospective review of all patients who underwent bladder neck closure between 1990 and 2010 at our institution. RESULTS: A total of 28 consecutive patients (exstrophy 15 and neurogenic bladder 13 [myelomeningocele 4, cloacal anomaly 4, spinal cord injury 2, VACTERL (Vertebral Anorectal Cardiac Tracheo-Esophageal Radial Renal Limb) 1, sacral agenesis 1 and urogenital sinus 1]) were identified. Of these patients 19 (68%) had undergone 20 unsuccessful bladder neck procedures before bladder neck closure. Bladder neck closure was initially successful in 27 of the 28 (96.4%) patients. One patient required subsequent closure of a postoperative vesicovaginal fistula. Median time from bladder neck closure was 69 months (range 16 to 250). In 11 patients 16 additional procedures were required, including stomal injection of bulking agents (2), stomal revision for stenosis (2) or prolapse (1), percutaneous nephrolithotripsy for stone (1), open cystolithotomy (2), extracorporeal shock wave lithotripsy for upper tract stones (4), repair of augment rupture (3) and open retrograde ureteral stenting for stone (1). The total surgical re-intervention rate was 39.3% (11 of 28). There were no observed cases of progressive or de novo hydronephrosis. CONCLUSIONS: Bladder neck closure in conjunction with enterocystoplasty and Mitrofanoff diversion is an effective means of achieving continence in complex cases as a primary or secondary therapy. Long-term urological followup into adulthood is essential.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it