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At least 1,207 records · Page 67Linked to original sources
PubMed2000

New methods of bladder augmentation.

Gastrointestinal segments are commonly used for bladder replacement or repair. However, when gastrointestinal tissue is in contact with the urinary tract, several complications may ensue. Recent surgical approaches have relied on native urological tissue for reconstruction. These are based on sound surgical principles, allowing for the exclusion of tissue that is not urological. De-epithelialized bowel segments, either alone or over native urothelium, have also been used. An experimental system of progressive dilatation for ureters and bladders has been proposed. This appears promising, although it has yet to be attempted clinically. There has been a resurgence of interest in the use of acellular collagen-based matrices as scaffolds for bladder regeneration; experimental work is currently underway. Recently, functional bladder tissue has been engineered using selective cell transplantation. This technique uses autologous cells, so avoiding rejection. Tissue is obtained from the host, the cells then dissociated and expanded in vitro, re-attached to a matrix and implanted into the same host. Clinical trials are currently being arranged. Even though the use of bowel for bladder tissue replacement was first proposed over 100 years ago, it remains the gold standard, despite its associated problems. It is evident that urothelial-urothelial anastomoses are preferable functionally. Experience is currently being gained with the recent clinical and experimental approaches to augmentation cystoplasty. It is hoped that this will result in more technologies and methods for bladder augmentation.

Animals↗
PubMed1991

Perforation of the augmented urinary bladder in nine children and adolescents: importance of cystography.

Augmentation of the urinary bladder is a popular surgical procedure for increasing the capacity and lowering the intraluminal pressure in patients whose bladder is small, noncompliant, or has high pressure. Among 250 augmentations performed at our hospital, nine patients have had 16 episodes of postoperative extravasation of urine from their augmented bladder. Thirteen episodes were studied by fluoroscopically monitored contrast cystography, which was diagnostic in 12. One patient's perforation was noted during an unrelated operation and the other two died of peritonitis before cystography could be performed. Four episodes occurred early, within 3 weeks of surgery. All were at a surgical anastomosis and presumably represented incomplete healing. Each patient with an early episode of extravasation had a perforation later. Nine perforations occurred from 1.0 to 6.5 months after the augmentation. Of these, three occurred at an anastomosis and four occurred in the augmenting segment. The locations of two were never fully documented. Three perforations occurred late, from 2.5 to 6.0 years after surgery, and all were in the augmenting segment. Three of the nine patients died of complications associated with perforation. Perforation of the bladder is not rare and is a potentially fatal complication of augmentation. Whenever a patient who has undergone augmentation has signs or symptoms suggesting perforation, cystography can play a crucial role in diagnosis and should be performed without delay.

Adolescent↗
PubMedDate not supplied

Management of ectopia vesica in Ibadan: an 8-year review.

CONTEXT: The management of children with ectopia vesica is intricate and complex. Repair of the bladder soon after delivery is desirable, particularly in our environment as the social stigma associated with such an anomaly can lead to child abandonment or infanticide. OBJECTIVE: To report our experience in the management of children with ectopia vesica at the University College Hospital (UCH), Ibadan, over an 8-year period. STUDY DESIGN, SETTING AND SUBJECTS: All children who presented at the UCH, Ibadan between January 1995 and December 2002 with ectopia vesica had the bladder closed primarily. The children that presented between 1995 and 1998 had the symphysial diastasis approximated with no. 1 nylon suture, while those that presented subsequently had the muscle and fascial layer closed with a darning suture of no. 1 nylon. RESULT: A total of 13 children presented with ectopia vesica during the period of the study. The bladder was closed in all cases. Abdominal wound dehiscence occurred less frequently in patients who had darning suture approximation of the muscle and fascial layer, compared with those who had simple symphysial approximation with nylon suture. CONCLUSION: The result of immediate bladder closure in children with ectopia vesica can be satisfactory in this environment. There is a need for continuing experience in the management of these children to improve outcome.

Bladder Exstrophy↗
PubMedDate not supplied

[The method of a complete one-stage urogenital reconstruction in extrophy of the urinary bladder and total epispadia in the adults].

In the context of surgical treatment of bladder extrophy/epispadia in the adults, the authors offer one-stage urogenital reconstruction, i.e. urethro-corporo-glanulo-sphyncteroplasty with penile preparation. Long-term results were analysed in adult patients with total epispadia and urine incontinence. Intact erectile function was observed in all 25 patients. An adequate function of the artificial muscular sphyncter was registered in 20 patients. The length of the penis increased from 2.5 to 5 cm. Sexual adaptation was achieved in 88% cases. Social adaptation occurred in all the cases.

Adolescent↗
PubMed1993

Sigma-rectum pouch (Mainz pouch II).

A substantial modification of the classic technique of ureterosigmoidostomy is introduced in this article. To date, this procedure has been used in 47 patients. This article reviews the surgical technique of the antemesenterial splitting of the intestine at the recto-sigmoid junction which creates a pouch by subsequent side-to-side anastomosis.

Bladder Exstrophy↗
PubMed1996

Continent urinary diversion using preputial penile or clitoral skin flap.

PURPOSE: We report our efforts to create an ideal continent urinary catheterizable stoma. MATERIALS AND METHODS: Our approach includes the creation of a continent stoma using a preputial penile island skin flap in male patients and a preputial clitoral island skin flap in female patients. The flaps are transposed suprapubically, tubularized and implanted in a nonrefluxing manner into the bladder or other urinary reservoir. RESULTS: From 1994 to April 1995 the technique was performed in 14 male patients 4 months to 42 years old and 7 female patients 4 to 14 years old. Early results were satisfactory at 2 to 12 months of follow up (mean 6). CONCLUSIONS: This technique could be an alternative to other methods of urinary continent diversion.

Adolescent↗
PubMed1992

Ileal nipple for continence in cloacal exstrophy.

Since 1985, 7 children 2 to 17 years old with urinary incontinence from cloacal exstrophy underwent bladder augmentation and creation of a small bowel nipple at the bladder outlet. There were 3 genetic female and 4 genetic male patients being reared in the female role. In 3 early cases augmentation was done with small bowel, while gastric augmentation was used in 3 later cases and 1 had both types. Six patients became completely dry and they empty by intermittent self-catheterization. In the youngest patient the operation failed because the nipple became infarcted and disappeared. Reoperation will be performed after at least 1 year has passed. In cloacal exstrophy if there is insufficient local tissue to create a bladder neck and urethra, a reversed, catheterizable bowel nipple may be an option to consider.

Abnormalities, Multiple↗
PubMed1988

The use of paraexstrophy flaps for urethral construction in neonatal girls with classical exstrophy.

Primary closure of classical exstrophy was performed with paraexstrophy skin flaps for urethral lengthening in 4 female neonates. In all cases more than 2.0 cm. of urethral length were achieved. Efficacy of bladder closure and subsequent bladder neck revision were enhanced by the use of these flaps. The technique of urethral construction is described and our results are discussed.

Bladder Exstrophy↗
PubMed2001

Non-visualisations of the fetal bladder: aetiology and management.

Failure to detect a normally filled fetal bladder on ultrasound scanning can imply the presence of a serious urogenital abnormality. Detailed scanning may elicit the underlying pathology, but there may be complex anomalies present, the full extent of which often has to await the results of postnatal investigations. Management in a combined paediatric urology:fetal medicine clinic is recommended.

Abnormalities, Multiple↗