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PubMed1963

[Bladder extrophy].

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Bladder Exstrophy↗
PubMed2004

Prevention of vesicoureteral reflux at the time of complete primary repair of the exstrophy-epispadias complex.

INTRODUCTION: With Mitchell's technique it is possible to perform bladder closure, reconstruction of epispadias and the bladder neck in one single procedure in an exstrophy patient. However the most common postoperative complication is pyelonephritis secondary to vesicouretral reflux. Reflux is closely linked to bladder exstrophy due to an abnormal anatomic development of the distal ureteral segment and to a pathologic bladder disposition. This problem is normally solved in subsequent surgical procedures. TECHNICAL CONSIDERATIONS: We decided to apply the technique described by Gil-Vernet as a first step of a bladder exstrophy repair following the Mitchell's technique. This ureteral advancement by means of trigonoplasty is a simple surgical procedure for vesicouretral reflux that preserves the intrinsic and extrinsic periureteral musculature. It is quite a short procedure that has yielded rates of success over 90%. CONCLUSIONS: The realization of this antireflux technique together with the primary closure could avoid later surgical correction in patients whose have had multiple operations.

Bladder Exstrophy↗
PubMed2006

Reconstruction of bladder and urethra using ileocecal segment and appendix in patients with exstrophy-epispadias complex: the first report of a new surgical approach.

OBJECTIVE: We aimed to describe our experience in administering an innovative surgical technique to treat pediatric cases of exstrophy-epispadias complex. MATERIAL AND METHODS: Between 1995 and 2004, seven consecutive patients (six males) with exstrophy-epispadias complex were treated using ileocecal segment for bladder augmentation and appendix for urethral reconstruction. In a single-stage operation, the exstrophied bladder was dissected- and a segment of cecum, ascending colon, terminal ileum, and the corresponding appendix were isolated. Using the opened colon to augment the bladder, the ileal segment was fashioned to skin as temporary stoma, and the appendix was laid in the urethral lumen as the neourethra following urethral demucosation. This technique was used as a secondary surgery in one case and as a primary surgery in six neonates. Evaluation of the urinary tract status was performed by cystograms and ultrasonograms. RESULTS: Renal function was saved in all cases and continence was achieved by clean intermittent catheterization every two hours either via the neourethra (n = 6) or through the temporary stoma (n = 1). The patients did not experience any metabolic complications in their follow-ups. Moreover, no one had vesicourethral reflux, dehiscence, or fistula. CONCLUSIONS: The technique was deemed safe with acceptable outcomes even when secondary repair of previously failed operation was intended. Experiencing the technique in larger cohorts as well as longer follow-ups might be necessary to assess probable long-term complications.

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