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PubMed1991

Horizontal pelvic osteotomies for bladder exstrophy. A preliminary report.

We have treated 11 patients aged three days to 15 years with bladder exstrophy by horizontal osteotomies of the innominate bones. The operation was originally used for older patients with severe deformity or failed previous surgery but is now applied as a primary procedure in the first week of life. The osteotomies enable the complex malformations to be corrected in a single operation without turning the patient: the pubic bones can be brought together, the abdominal wall repaired and the bladder closed with reconstruction of the urethra and external genitalia. The early results have been very satisfactory in all cases with only minor complications; we felt that a preliminary report should be made, despite a mean follow-up of only seven months.

Adolescent↗
PubMed1976

Long-term results of surgical treatment of bladder exstrophy.

A review of the long-term results of the treatment of 18 cases of bladder exstrophy is reported. Five cases have been operated on before 1961 by ureterosigmoidostomy; 4 (80%) patients have good renal function and have not had any complications, although 1 patient has anal incontinence; 1 patient presented bilateral renoureteral complications, requiring several corrective operations, and has anal incontinence too. Out of 13 cases operated on after 1961, 10 have been followed up from 3 to 14 years. In 1 patient an ileal conduit was performed because of the failure of an ureterosigmoidostomy performed at another hospital 10 years before. In 9 patients a personal technique based on the bladder substitution by a colonic loop plus creation of a sphincteric mechanism by trigonal tubulization was used (enterotrigonal urethroplasty). Morbidity has been high (66.6%), but the end results are very satisfactory: 7 patients (77.7%) are currently living a normal life, with normal renal function and good continence; 1 patient is incontinent and has bilateral reflux and a left retracted kidney; 1 patient has been secondarily diverted by means of a cutaneous Y transuretero-ureterostomy due to gross lreteral dilatation, renal damage and incontinence.

Adolescent↗
PubMed1983

Ureterosigmoidostomy in bladder exstrophy.

Experience with ureterosigmoidostomy (US) using a reflux prevention technique in 38 of 48 cases of bladder exstrophy is reviewed. During a follow-up period of 14 years, the results were excellent as to morphological changes of the upper urinary tract, incontinence, psychological development and social behavior. Within their families the patients are considered healthy. Even in children with benign disease, US with reflux prevention performed during the second year of life is the operation of choice for urinary diversion. In the postoperative follow-up it is recommended that sigmoidoscopy be performed once a year in addition to routine controls of the upper urinary tract and metabolic balance.

Adolescent↗
PubMed1991

Nephrogenic adenoma with bladder exstrophy and immunosuppression.

Nephrogenic adenoma, an unusual proliferative lesion, often occurs in association with chronic inflammation of the bladder and is rarely found in children. Two cases are reported, one occurring in a young child born with bladder exstrophy, and one in a young female, with both interstitial cystitis and chronic use of immunosuppressive therapy. We believe these are the first case reports of nephrogenic adenoma occurring in this specific clinical setting.

Adenoma↗
PubMed1981

Pregnancy in women after repair of bladder exstrophy. Two case reports.

Improved techniques in urinary diversion operations have enabled a large number of patients with bladder exstrophy to achieve urinary control. They can live fairly normal lives and some have achieved pregnancy. Case reports of such exist in the literature. Two more cases are reported in this paper, the pregnancies and their outcome are discussed.

Adult↗
PubMed1994

[One stage reconstruction of bladder exstrophy and epispadias with abdominal wall skin flap and rectus abdominis muscle flap: report of 5 cases].

5 cases of complete bladder exstrophy were treated by one stage reconstruction with abdominal wall skin flap and rectus abdominis muscle flap. Closure of the abdominal wall and bladder defect were achieved satisfactorily in all the patients. 4 patients have been followed up for 1.5-10.5 years. 3 patients whose bladder neck had been augmented by rectus abdominis muscle flap were continent but 1 patient whose bladder neck had not been, had giggle incontinence. The renal functions were all normal in these patients.

Adult↗
PubMed1988

Primary closure of bladder exstrophy: long-term functional results in 137 patients.

Between 1945 and 1985, 207 patients were treated at our institution for exstrophy of the urinary bladder. Primary anatomical bladder closure was performed in 137 patients. In 97 patients treated prior to 1975, bladder closure was performed at a median age of 1 year and continence in this group was only 16%. Forty patients treated after 1975 underwent closure at a median age of 72 hours followed by staged reconstruction of the bladder neck. Continence in this group was 82%; however, the average number of surgical procedures was five as compared with two in the first group. Early bladder closure and staged reconstruction can achieve acceptable urinary continence, but multiple surgical procedures may be required.

Bladder Exstrophy↗
PubMed1995

Epidermolysis bullosa junctionalis associated with urinary bladder exstrophy: a case report.

We report the second infant of nonconsanguineous parents with epidermolysis bullosa junctionalis associated with urinary bladder exstrophy, epispadias, anteriorized anus, and bilateral inguinal hernias. The family history also included the death of a maternal cousin due to epidermolysis bullosa. Our diagnosis was based on electron microscopy and immunofluorescence evidence. This patient is reported because of the rarity of this constellation of findings.

Abnormalities, Multiple↗
PubMed1986

[Experience with reconstructive-plastic operations in bladder exstrophy in children].

The author analyzes the experience with reconstructive-plastic operations in her modification mad in 22 children with exstrophy of the urinary bladder. Long-term results within 3-17 years were observed in 15 children. Good outcomes (complete retaining of urine, normal capacity of the bladder, good morphofunctional state of the kidneys) were noted in 8 children. Based on the results obtained the author recommends the surgical treatment of exstrophy of the urinary bladder to be started with reconstructive-plastic operations at the age of 1-3 years.

Bladder Exstrophy↗
PubMed1992

20 years of functional reconstructive surgery in bladder exstrophy--balance 10 years after a preliminary report.

This is an update of a consecutive series of 19 patients with bladder exstrophy presented as a preliminary report 10 years ago with a follow-up of 6 years. The average time of follow-up now is 14 years. In difference to the former report several additional procedures have been performed in most patients. 3 early "good" patients stay "good and continent". Only 3 out of 5 patients categorized as "fair" are now "good and continent" and only one without further intervention. 3 out of 6 patients who were classified as "poor" are now diverted. The overall rate of secondary diversions is 40% including 2 patients with ureterosigmoidostomies. All patients have normal renal function and normal blood pressures. These results show that an early "good" result generally remains "good" but additional surgery may be warranted. The initially "fair" results usually necessitate a secondary procedure, e.g. augmentation cystoplasty or/and bladder neck tightening to show an improvement. Patients with early "poor" results unfortunately remain "poor" and have a great chance to get diverted.

Bladder Exstrophy↗
PubMed1980

Renal function in continent patients after surgical closure of bladder exstrophy.

We assessed the upper urinary tracts and renal function in 22 children who had achieved continence after staged correction of bladder exstrophy. All patients had been followed for an average of 8 years after completion of the reconstructive operation. In 15 patients the upper urinary tract was normal and only 1 of the remaining 7 required surgical correction (transureteroureterostomy) of the residual anomaly. Renal function was normal in all children. We attribute these satisfactory results to careful selection of patients, improved surgical techniques and good postoperative care.

Adolescent↗
PubMed1989

[Bladder exstrophy and quality of life].

The primary objectives of operative management of exstrophy of the urinary bladder are to obtain secure closure of pelvic girdle and abdominal wall, unimpeded voiding, urinary continence, absence of reflux, preservation of renal function, functional and cosmetically acceptable external genitalia, and the absence of malignancy. These objectives cannot be fully achieved by only one of the established procedures such as functional bladder closure, internal or external urinary diversion and epispadias repair. Early individual and creative surgical management including changing concepts when needed and careful life-long followup are thought to provide the basis for a satisfying social adjustment and quality of life.

Adolescent↗
PubMed1990

[A rare case of bladder exstrophy with a completely malformed complex in a girl].

Report of the observation of a female newborn presenting a complex malformative set: distal anorectal malformation without fistula; bladder exstrophy without epispadias, with cutaneous bridge; congenital urethrovaginal fistula; malformative sexual ambiguity with bulky genital tubercle, whole urethra, urethral meatus on the apex of the genital tubercle, associated with a mid labial genital joint and a high genital orifice; unilateral multicystic kidney; vertebral abnormalities with supernumerary thoracolumbar vertebrae; no karyotype abnormalities and no familial pathological history; no endocrine abnormalities. The therapeutic multistage program permitted a good reconstruction of the different lesion, particularly with bladder functioning witch in hope a good continence with two years of follow-up. No similar case is reviewed in the literature.

Abnormalities, Multiple↗