VOLUME OF SURGERY IN THE PRIMARY CLOSURE OF BLADDER IN CHILDREN WITH BLADDER EXSTROPHY

Introduction. Bladder exstrophy is one of the most complex malformations in pediatric urology. Material and methods. In 1996-2019, 112 children with bladder exstrophy, aged 2 -32 days, had a “primary bladder repair” in St Vladimir Children’s Municipal Clinical Hospital. All children (112) were divided into groups depending on dimensions of the cystic area: large bladder size (over 5 cm) - 39 (34.8%) patients; average size (35-50 mm) - 43 (38.9%); small size (less than 35mm) - 31 children (27.6%). Subgroup “A” - 77 patients (68.7%) were treated in 1996 - 2012, and the primary bladder closure was performed at their neonatal period regardless of the area size. Subgroup “B” - 35 children (31.2%), operated on in 2013-2019, had various volume surgeries depending on clinical manifestations. These groups are homogeneous and comparable in age and manifestations. Results. Complications after surgery were seen in 20 children (25%) from Subgroup “A”: exstrophy relapse - 14 (18%), divergence of bladder neck - 6 (7%). The outcome analysis has shown that the highest rate of exstrophy relapses and cervical divergence was observed in children with microcystis - 15 (57.4%) out of 21. In Subgroup “B”, exstrophy relapse was observed in 1 (2.8%) child with an average bladder size; cervical divergence - in 2 (5.6%) children with an average size and in 2 (5.6%) with microcystis. The number of complications in children with microcystis was reduced from 15 out of 21 children (71%) in Subgroup “A” to 2 out of 10 patients (20%) in Subgroup “B”. Conclusion. A differentiated approach to the choice of surgery volume and proposed additional measures lead to better bladder growth and better urine retention after the first surgery.