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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↗
PubMed1993

[Functional reconstruction of urinary bladder exstrophy: long-term follow-up of urinary continence].

The author followed up a group of seven patients 5 to 29 years after functional reconstruction without augmentation on account of classical exstrophy of the urinary bladder. The plastic operation to ensure continence was performed in 5 boys and 2 girls at the age of two and a half to 23 months, in six cases by the Young-Dees' method and in one patient by Leadbetter's method. Posterior iliac osteotomy was performed in two and an antireflux plastic operation was performed in four patients. In one patient a disruption of the plastic operation of the abdominal wall occurred on the fourth day after reconstruction. Continence was excellent in five patients and satisfactory in two. Among the many factors for urinary continence a plastic operation of the posterior urethra and neck of the bladder is most important as it creates the appropriate length of the continence zone and the adequate pressure on closure. In the discussion the author emphasizes the advantage to start with the reconstruction of the abdominal wall and bladder during the neonatal period and to proceed in stages. The functional closure of the bladder and its neck with the posterior urethra should be implemented after a minimal capacity of 60 ml has been attained. Augmentation enterocystoplasty is indicated on account of urinary incontinence as a secondary operation if the function of the urethra and neck of the bladder is satisfactory and achieved capacity is less than 100 ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Bladder Exstrophy↗
PubMed1993

Flaps for the repair of bladder exstrophy.

From April 1986 to March 1992, flaps were used in the surgical treatment of 17 patients with congenital bladder exstrophy. Eleven of these patients had had surgery in other hospitals but all failed. Using the flap method for the repair all of them had procured a functional bladder except one who could not have a complete control of urination. The longest follow-up period was 3 years, and the renal and bladder functions were completely normal. The immediate result in 14 patients was good in the control of urination right after the removal of the catheter. The follow-up results were good in 16 cases. The flaps used included 8 types of skin flaps, fasciae and vascular pedicles. Provided with the central vascular supply, the new series of procedures were suitable for the treatment of a variety of exstrophy deformities.

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↗
PubMed1989

Current management of bladder exstrophy: a BAPS collective review from eight centres of 81 patients born between 1975 and 1985.

The British Association of Paediatric Surgeons (BAPS) agreed to collect information on bladder exstrophy from its members. Data were obtained on 81 patients from eight centres. Twenty-one patients had other congenital abnormalities. Three died within the first year of life, and one was lost to follow-up in the early neonatal period--leaving 77 for further analysis. Forty patients had bladder closure without permanent urinary diversion. Ten were able to stay dry for two hours or longer, and 16 were constantly wet. Of the remaining 14, some were too young to assess, while others were dry for from 30 minutes to two hours. Thirty-seven had undergone diversions; fourteen had ureterosigmoidostomy, nine underwent ileal loop conduit, nine had colon loop conduit, and five had cutaneous ureterostomy. Seventeen of these diversions had been carried out before the patients were 2 years of age.

Adolescent↗
PubMed1995

Prevalence and repair of inguinal hernias in children with bladder exstrophy.

PURPOSE: We delineated the prevalence, recurrence rates and optimal treatment of inguinal hernia in the exstrophy population. MATERIALS AND METHODS: Of 181 children with exstrophy followed at our hospital inguinal hernias developed in 121 (66.8%). RESULTS: In a 12-year period inguinal hernias developed in 81.8% of the boys and 10.5% of the girls. In 18.2% of the cases the hernia was repaired via a preperitoneal approach at the same time as exstrophy closure. The remaining patients underwent an inguinal operation. Most patients had a wide defect at the internal ring in addition to a patent processus vaginalis. The overall recurrence rate was 8.3%. The incidence of synchronous or asynchronous bilaterality was 81.8%. CONCLUSIONS: Children with bladder exstrophy should be carefully examined for inguinal hernias before bladder closure. If a unilateral hernia is present, the contralateral side should be explored. Careful preperitoneal repair should emphasize repair of the internal ring.

Adolescent↗
PubMed1993

Cosmetic reconstruction of the mons veneris and lower abdominal wall by skin expansion as the last stage of the surgical treatment of bladder exstrophy: a report of three cases.

The results of the correction of the medial scar depression and diastasis of the pubic hair of the mons veneris in three postpuberal female patients operated on for bladder exstrophy are reported. The reconstructive surgery is carried out using skin expanders. The expanded skin is utilized to create two dermoadipose flaps to fill the medial depression, to outline again the public hair areas, and to allow sutures without tension.

Abdominal Muscles↗
PubMed1980

[Bladder exstrophy. Transformation from an external diversion of the urine to an internal diversion].

It is possible to transform an external diversion (transcolic cutaneous ureterostomy) into an internal one (uretero-sigmoido-sigmoidostomy) in cases of bladder exstrophy which have not been reconstructed. This must not be done at too early an age (not before 7) and only under certain conditions : good renal function, normal upper urinary tract, no sigmoido-ureteral reflux good anal sphincter. Such an operation radically changes the life of the exstrophic who was previously handicapped by a collecting apparatus. One must assure a careful long term follow-up. The major details of technique and the results of 20 cases are described.

Adolescent↗