Abstract
BackgroundUrinary incontinence is a major problem in operated exstrophy patients. Most of the repairs described in literature stress on the importance of dividing the intersymphyseal band (ISB) to place the bladder in the pelvis. But the origin of this band and its importance has hardly been discussed in literature. The purpose of this study is to establish the nature of tissue the ISB is composed of. This can be used to determine its role in the surgical management of exstrophy epispadias complex (EEC) patients.ResultsThirty out of 33 operated patients demonstrated smooth muscle with/without fibrous tissue in the sections taken through the ISB.A significant percentage of patients (χ2= 38.319, p < 0.0001) in whom this band was reconstructed around the bladder neck gradually became continent/partly continent with an increase in the dry interval with time.ConclusionIt can be a considerable factor to pay attention to the step of wrapping the ISB around the bladder neck during EEC repair. This serves to function as the smooth muscle of the bladder neck as proven histologically in our operated patients. It may have a role to support future continence in these patients.
Highlights
Urinary incontinence is a major problem in operated exstrophy patients
Histopathology study On histopathological analysis of the intersymphyseal band (ISB) in the 26 primary cases operated, 25 patients showed smooth muscle (Fig. 3)
The ISB represents the smooth muscle of the bladder neck in patients of exstrophy
Summary
Urinary incontinence is a major problem in operated exstrophy patients. Most of the repairs described in literature stress on the importance of dividing the intersymphyseal band (ISB) to place the bladder in the pelvis. The importance of the intersymphyseal band (ISB) in the repair of exstrophy-epispadias complex (EEC) is highlighted in the need to divide this band in order to push the bladder into the pelvis [1]. The origin of this structure considering its normal anatomic counterpart largely remains vague. Instead of merely dividing the ISB during primary exstrophy repair, reconstruction of this band by wrapping it around the bladder neck restores normal anatomy in EEC patients This reconstructed ISB may play a significant role in keeping patients dry post-operatively. This is because it helps to develop a near normal mechanism of providing a dynamic resistance to urine flow at the bladder neck or outlet
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