Modified VQZ-Plasty for the Creation of a Catheterizable Stoma Suitable as a Neoumbilicus in Selected Bladder Exstrophy Patients

Abstract

To present a modified VQZ-plasty technique to create a catheterizable stoma appearing as a normal-looking neoumbilicus that may be used in selected bladder exstrophy (BE) patients. A catheterizable conduit is created according to the Mitrofanoff principle. An asymmetric V flap, with the base at the level selected as the upper margin of the neoumbilicus, is created and incorporated into the spatulated appendix. Then a Q flap is developed parallel to the shorter margin of the V flap, rotated, and anastomosed to the upper edge of the appendix and to the free margin of the V flap on the contralateral side. The skin gap is filled by a rotational flap overlying the emerging appendix and stoma site. To date the technique has been used in 2 BE patients. After a follow-up of 10 and 6 months, respectively, both have good cosmetic and functional results, with an easily catheterizable stoma. The described technique allows for the creation of a nearly ideal stoma that looks like a normal neoumbilicus in selected BE patients yet without an umbilicus and requiring the placement of a catheterizable conduit.