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At least 1,099 records · Page 61Linked to original sources
PubMed1984

Fecal continence following an anterior-sagittal ano-enteroplasty in a patient with cloacal exstrophy.

A two-year-old Latin American female was referred for treatment of what appeared to be a straightforward case of cloacal exstrophy. At operation, incision along the superior margin of the exstrophic bladder allowed identification of an unusual variant of exstrophy which consisted of bladder exstrophy; erminal colon duplication, the common medial wall of which protruded 8 cm beyond the end of the bowel lumen, and which exited ventrally and immediately caudad to the exstrophic bladder; an enteric diverticulum at the superior rim of the bladder; and two small vaginae, existing laterally on either side, at the junction between the bladder and the terminal bowel. The terminal bowel was mobilized, the duplications were excised, and a tapering enteroplasty was performed. Despite a flat-appearing bottom, a posterior muscle complex was identified which extended anterolaterally and attached to the pubis on either side. Following observation of an appropriate response to electrical stimulation, the muscle complex was partially divided in the midline, from anterior to posterior, just enough to make room for the tapered bowel. The muscle was then reapproximated in the midline anteriorly, surrounding the bowel, and an anoplasty was constructed. The bladder was closed, and the pubic rami were wired together (bilateral posterior iliac osteotomies were performed at the beginning of the operation). One and 1/2 years following this procedure, the child has a normal "rectal" exam with a palpable sphincter. She has 3 to 4 solid bowel movements daily without soiling, and she awaits genitourinary reconstruction.

Abnormalities, Multiple↗
PubMed1986

Adenocarcinoma in extrophy of the bladder. A case report and review of the literature.

There have been 81 cases of carcinoma in extrophied bladder described previously. We describe another such case. It demonstrates the problem of early diagnosis of carcinoma in extrophy of the bladder and the therapeutic consequences of an early cystectomy. In accordance with current literature we illustrate the theories on oncogenesis, and review the cases previously published.

Adenocarcinoma↗
PubMed2002

[Functional anatomy and semiology of the bladder].

Continence and micturition result from an inversely related evolution of urethra and bladder pressures. On filling, the bladder pressure remains low and the urethral pressure is high: filling bladder pressure mainly depends on its visco-elastic properties while urethral pressure is actively kept high by the tonic activity of smooth and striated urethral sphincters. It is the other, way round when the bladder empties: bladder pressure rises and urethral pressure lower, because the parasympathetic impulses; in the adult, the reflex loop passes through the pontine center. The volitional control of this micturitional reflex implies an ability to recognize a specific feeling: the desire to urinate. Physical examination and investigations enables to assess bladder and sphincter function, through a rich semiology.

Adult↗
PubMed1992

[Urinary diversion by means of uretero-ileostomy. Long-term results].

The authors analyze a group of 187 patients where in 1969-1991 a ureteroileostomy was performed on account of malignant tumours (89.8%) or other diseases (10.2%). Ureteroileostomy was indicated along with cystectomy in 77 patients with tumours of the urinary bladder (63 times), with gynaecological carcinoma (21 times) and in tumours of the urethra and rectum (7 times). Indications in non-tumours diseases comprised a neurogenic bladder (10 times) exstrophy of the urinary bladder (6 times), post-traumatic incontinence of urine in women (twice) and iatrogenic injuries of the ureters (once). In all patients an anastomosis between the ureter and excluded loop, as described by Wallace, was used. The surgical mortality was 5.3%. During the immediate postoperative period 96 complications developed in 91 (51.3%) patients. As to late complications, most frequently complications of the stoma of the excluded loop were involved. Ureteroileostomy gives satisfactory results in the majority of patients, however, the number of complications is not negligible. The authors discuss the selection of derivation methods under our conditions.

Adolescent↗
PubMed2001

Modified Young-Dees-Leadbetter bladder neck reconstruction in patients with successful primary bladder closure elsewhere: a single institution experience.

PURPOSE: Achievement of urinary continence in patients with the exstrophy-epispadias complex remains a challenge. We reviewed our experience with the modified Young-Dees-Leadbetter bladder neck repair in patients with bladder exstrophy who underwent primary bladder closure elsewhere. MATERIALS AND METHODS: We retrospectively reviewed exstrophy charts and database of 57 male and 11 female with classic bladder exstrophy who underwent bladder neck repair at our institute and successful primary bladder closure elsewhere during the last 2 decades. Osteotomy was performed at primary closure in 14 (20%) cases and 9 (13%) patients at bladder neck repair in 9 (13%) to aid in stabilizing the urethra and pelvic ring, and to help reapproximate the pelvic floor musculature facilitating urinary continence. RESULTS: Primary closure was done within 72 hours of life elsewhere in 41 (60%) patients, and between ages 72 hours and 5 years (most during the first month of life) in 27. Paraexstrophy skin flaps were used in 33 (48%) cases, and the most common complication was bladder outlet obstruction of the posterior urethra secondary to the skin flaps. Of the 68 patients 57 (83%) are continent and voiding per urethra without need for augmentation or clean intermittent catheterization, 9 (13%) required clean intermittent catheterization including 7 who underwent continent urinary diversion after failed bladder neck repair, and 2 are still incontinent due to a severe posterior urethral stricture. Urinary retention was the most common symptom after bladder neck repair which resolved following catheter dilation or prolonged suprapubic catheter drainage. CONCLUSIONS: Successful early primary closure of a good bladder template is the most important determinant of eventual bladder capacity and compliance.

Adolescent↗