What is bladder neck reconstruction (BNR)?
Bladder neck reconstruction (BNR) is a surgical option used to treat urinary incontinence. BNR can occur during an initial reconstruction for bladder exstrophy or epispadias, or as an isolated procedure at a later period in patients who had prior surgeries. BNR is done in a single operation and usually does not require osteotomies (cuts in the pelvic bone).
For some patients whose bladder is a good size and working well, we can perform BNR with the goal of allowing them to urinate on their own — without needing a catheter or bladder enlargement using a piece of bowel.
To determine whether BNR can be done without other procedures, we typically assess the bladder and urethra in the operating room and use imaging studies to guide the decision.
What happens during BNR?
During bladder neck reconstruction (BNR), a team of surgeons carefully narrows and repairs the area where the bladder connects to the urethra, which helps improve urinary control. In some cases, additional procedures may be done at the same time to support continence or improve the appearance of the external genitalia.
BNR is a complex surgery that can take several hours, and your child will need to stay in the hospital for recovery. Our care team will provide step-by-step instructions and ongoing support to help guide you through the healing process.
What to expect after surgery
After bladder neck reconstruction (BNR), your child will stay in the hospital for about one week. Most children do not need care in the ICU after this procedure. During their stay, your child will receive IV fluids, pain relief (often through an epidural catheter), and have tubes in place to drain the bladder and support healing.
It's common for children to experience bladder spasms, which can feel uncomfortable. An epidural pain catheter is typically placed in the operating room for pain control, and the care team will provide medications to help manage these symptoms. As your child begins to recover, we’ll encourage gentle movement to support healing.
Once your child goes home, the care team will stay in close contact with you, offering ongoing guidance and support to help your child gradually return to their usual routine.
How Boston Children’s approaches BNR
BNR is performed by experts in our Bladder Exstrophy Program, where a team of specialists brings deep experience in treating this rare and complex condition.
Many older children and teens who continue to have urinary incontinence after earlier bladder exstrophy surgery come to our team for evaluation and guidance.
We take a personalized, family-centered approach, making sure your child is fully prepared for surgery — and that you feel informed, supported, and involved throughout the entire process.
Bladder Neck Reconstruction | Programs & Services
Programs
Bladder Exstrophy Program
Program
The Bladder Exstrophy Program specializes in the care of children with bladder exstrophy, a rare and complex birth defect in which the bladder is turned "inside out."
