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At least 613 records · Page 34Linked to original sources
PubMed1993

The failed exstrophy closure: strategy for management.

In the last 7 years, 29 boys and 11 girls have been referred with failure of their exstrophy closure; 38 patients had classic bladder exstrophy and 2 had cloacal exstrophy. Reclosure was performed for complete bladder dehiscence in 28 cases and for significant bladder prolapse in 10. Two patients underwent revision of the posterior urethra after primary closure due to a severe urethral stricture secondary to the use of para-exstrophy skin flaps. Six patients underwent posterior iliac osteotomy at the time of initial bladder closure and in 34 no osteotomy was performed. Thirty-seven patients underwent either posterior iliac osteotomy (15) or anterior innominate osteotomy (22). Epispadias repair together with reclosure of bladder exstrophy was done in 20 boys. The upper tract has remained normal in all patients. Fourteen have undergone subsequent bladder neck reconstruction. Seven patients have undergone simultaneous bladder neck reconstruction and augmentation cystoplasty and 1 has undergone augmentation cystoplasty and Mitrofanoff procedure; all are dry on intermittent self-catheterisation. The failed exstrophy reconstruction represents a formidable dilemma. However, a well planned reconstruction including osteotomy (even if previously performed), reclosure with or without epispadias repair or revision of the urethra can be performed with an excellent chance of proceeding with staged reconstruction.

Bladder Exstrophy↗
PubMedDate not supplied

Posterior iliac osteotomy in ischiopagus tetrapus twins.

Eight hemipelvises in ischiopagus tetrapus conjoined twins were assessed retrospectively to determine whether posterior iliac osteotomy is appropriate to reconstruct pelvic symmetry. Although clinical and radiological similarity exists with classic bladder exstrophy, axial and three-dimensional computed tomography showed the pelvic deformity to be very different. In classic bladder exstrophy, the deformity is one of shortening and external rotation of the anterior segment, and external rotation of the posterior segment. The deformity in the ischiopagus tetrapus pelvis is purely one of external rotation of the posterior segment. Posterior iliac osteotomy alone was therefore able to restore pelvic symmetry in seven of the eight hemipelvises, and prevented rediastasis of the symphysis pubis in all patients.

Bladder Exstrophy↗
PubMed1981

[Staged functional closure of bladder extrophy (author's transl)].

Two surgical alternatives exist in the treatment of classic bladder exstrophy: urinary diversion and functional closure. The staged ureterosigmoidostomy is the treatment of choice for patients not suitable for bladder and urethral reconstruction. The treatment of the patients selected for closure begins by closing the bladder during the neonatal period. Osteotomy appears to be necessary in children older than 2 days. Incontinence and vesico-ureteral reflux are treated by bladder neck-urethral reconstruction and reimplantation of the ureters at three years of age. Closure of the epispadias follows in the fifth year. It may be necessary to treat upper tract complications by secondary urinary diversion. Concerning incontinence, technical improvement in artificial sphincter may soon offer an alternative to urinary diversion. The results of 70 primary bladder closures selected from 94 patients presenting with bladder exstrophy are presented: 54 patients with long-term follow-up and completed staged repair were available for assessment: 31 (57.5%) proved to have a good result and 10 (18.5%) to have a fair results. 13 (24.0%) were completely incontinent or required diversion. Failures were thought to be the results of inadequate selection or failure to achieve continence.

Adolescent↗