Staged Male Bladder Exstrophy Repair

Selection For ◽

This chapter details the latest surgical advances and outcomes in the modern surgical management of male classic bladder exstrophy to include patient selection for closure, operative considerations, newborn primary bladder and posterior urethral closure, early epispadias repair, bladder neck reconstruction with an antireflux procedure, and postoperative management. It highlights how to achieve the primary objectives of (1) a secure abdominal closure, (2) reconstruction of a functional and cosmetically acceptable penis, and (3) urinary continence with the preservation of renal function. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This review contains 3 figures, 5 tables, and 47 references. Key Words: Congenital defect, Bladder exstrophy, Epispadias, Reconstruction, Urinary Continence, Magnetic Resonance Imaging, Pain management, Pelvic osteotomy

Female Bladder Exstrophy Repair

10.2310/uro.11027 ◽

2019 ◽

Author(s):

Timothy S. Baumgartner ◽

John P. Gearhart

Keyword(s):

Sexual Function ◽

Pelvic Floor ◽

Key Words ◽

Patient Selection ◽

Bladder Exstrophy ◽

Urinary Continence ◽

Pelvic Floor Reconstruction ◽

Surgical Interventions ◽

Female Bladder ◽

Selection For

This chapter details the latest surgical advances and outcomes in the modern surgical management of female classic bladder exstrophy to include patient selection for closure, operative considerations, and outcomes. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This chapter also reviews the incidence, embryology, and anatomic considerations when approaching the treatment of the exstrophy patient. This review contains 4 figures, and 36 references. Key Words: bladder exstrophy, congenital defect, embryology, epispadias, pelvic floor, reconstruction, sexual function, urinary continence

Orthopaedic Management of Bladder Exstrophy

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.25986 ◽

2021 ◽

Author(s):

R. Özgür Özer

Keyword(s):

Abdominal Wall ◽

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Orthopedic Procedures ◽

Suture Materials ◽

Cloacal Exstrophy ◽

Surgical Interventions ◽

Pubic Rami ◽

Multi Stage ◽

Pubic Diastasis

Bladder exstrophy is an embryologic malformation that affects urogenital and skeletal systems. Non-operative treatment of this rare problem is impossible. Urogenital reconstructions can be facilitated by orthopedic procedures. These reconstructions can be performed in a single stage as a complete repair or multi-stage approaches. The goal of the treatment is closure of the bladder and abdominal wall for the achievement of continence, preservation of renal functions, and cosmetic and functional reconstruction of genital organs. Orthopedic procedures are performed to decrease the tension that complicates the bladder and abdominal wall closure by approximating the pubic rami to achieve a secure closure and a low recurrence rate. Surgical interventions consist of the approximation of the pubic rami with different materials such as suture materials and plaque or the application of different osteotomy types such as posterior iliac, anterior pelvic (pubic), diagonal iliac, horizontal iliac and posterior pelvic resection osteotomies. The age of the patient, the amount of pubic diastasis and history of previous operations that the patient has undergone should be considered during the operation planning. Pubic rami can be approximated without performing pelvic osteotomy in patients who are operated within the first 72 hours after birth. But, osteotomy is required in children older than 2 years of age with severe pubic diastasis, concomitant cloacal exstrophy and unsuccessful operation history. The surgical team should have enough knowledge and experience to perform different osteotomy types in case of need to combine anterior and posterior iliac osteotomies. With these multidisciplinary approaches, much more successful outcomes could be achieved.

201 BLADDER NECK RECONSTRUCTION IN PRIMARY BLADDER EXSTROPHY-EPISPADIAS COMPLEX CLOSURE

European Urology Supplements ◽

10.1016/s1569-9056(11)60203-0 ◽

2011 ◽

Vol 10 (2) ◽

pp. 86

Author(s):

Y.E. Rudin ◽

T.N. Garmanova ◽

D.V. Maruchnenko ◽

Y.E. Chekeridi

Keyword(s):

Bladder Neck ◽

Bladder Exstrophy ◽

Neck Reconstruction ◽

Primary bladder closure and bladder neck reconstruction in classical bladder exstrophy

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(84)80313-9 ◽

1984 ◽

Vol 19 (4) ◽

pp. 495

Author(s):

George Holcomb

Keyword(s):

Bladder Neck ◽

Bladder Exstrophy ◽

Neck Reconstruction ◽

Exstrophy of the Bladder

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.18.2.17 ◽

1999 ◽

Vol 18 (2) ◽

pp. 17-26 ◽

Cited By ~ 4

Author(s):

Jeannie Mollohan

Keyword(s):

Urinary Tract ◽

Surgical Care ◽

Upper Urinary Tract ◽

Surgical Interventions ◽

Variable Success ◽

Primary Bladder ◽

The Many ◽

Ventral Wall ◽

Exstrophy Of The Bladder

Exstrophy of the bladder is a rare congenital defect that occurs when the abdominal wall and underlying structures, including the ventral wall of the bladder, fail to fuse in utero. As a result, the lower urinary tract is exposed, and the everted bladder appears through the abdominal opening. Various surgical interventions have been employed with variable success in the hope of achieving complete dryness, full control over delivery of urine, freedom from catheters and external appliances, and a protected upper urinary tract. The most popular surgical approach is the primary bladder closure with secondary bladder neck reconstruction. Comprehensive nursing, medical, and surgical care are necessary to preserve renal and sexual function. The many complex problems experienced by these infants and their families call for a multidisciplinary approach. This article reviews occurrence, clinical presentation, and management of exstrophy of the bladder.

Re: The Modern Staged Repair of Classic Bladder Exstrophy: A Detailed Postoperative Management Strategy for Primary Bladder Closure

The Journal of Urology ◽

10.1016/j.juro.2013.04.086 ◽

2013 ◽

Vol 190 (2) ◽

pp. 696-697

Author(s):

Douglas A. Canning

Keyword(s):

Management Strategy ◽

Bladder Exstrophy ◽

Postoperative Management ◽

Long-term functional outcomes after bladder exstrophy repair: A single, low-volume centre experience

Canadian Urological Association Journal ◽

10.5489/cuaj.3104 ◽

2016 ◽

Vol 10 (3-4) ◽

pp. 94 ◽

Cited By ~ 2

Author(s):

Ossamah Alsowayan ◽

John Paul Capolicchio ◽

Roman Jednak ◽

Mohamed El-Sherbiny

Keyword(s):

Primary Repair ◽

Bladder Exstrophy ◽

High Volume ◽

Bladder Capacity ◽

Urinary Continence ◽

Number Of Patients ◽

Low Volume ◽

Continence Rate ◽

The Cost

Introduction: In this study, we present our experience managing bladder exstrophy (BE) in a low-volume centre over 24 years.Methods: Charts of patients with BE between 1990 and 2014 were retrospectively reviewed. Patients with BE closure and ≥5 years followup were included. BE closure was carried out in the first two days of life using either complete primary repair (CPRE) or modernstaged repair (MSRE). Daytime urinary continence (UC) was evaluated by the age of five years. Patients were considered continent if completely dry for ≥3 hours using no or one pad/day. Incontinent patients with bladder capacity (BC) ≥100 ml underwent bladder neck reconstruction (BNR) and bilateral ureteric reimplantation(BUR), while patients with BC <100ml underwent simultaneous augmentation cystoplasty (ACP).Results: Sixteen (16) patients met our inclusion criteria with a mean followup time of 18±5 years. Ten (10) underwent CPRE, while six underwent MSRE. Four surgeons were involved in patients’ management. Two surgeons had previous experience in BE surgery while working in other institutions. Complications included dehiscence in five patients, vesicocutanous fistula in three and breakthrough UTI in eight. Continence was achieved in 15/16 patients: two after BE closure only, seven with BNR, and six who required ACP and BNR.Conclusions: Despite the small number of patients and the reterospective nature of the study, some observations are noteworthy. Although continence rate post-primary BE closure was initially low, it rose to 93.8% after auxiliary continence procedures. This might be at the cost of urethral voiding, which was achieved in 60% of patients. Our small cohort did not show clear advantage of CPRE vs. MSRE. Our outcomes may not be different from high-volume centres due to the fact that two exstrophy-experienced surgeons performed most primary or subsequent surgeries. For this reason, we recommend assigning designated centres for BE repair for both new and repeat cases.