Abstract
ABSTRACTIntroduction The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant.Objective To present our experience of our modified one-stage reconstruction of bladder exstrophy in male patients.Materials and Methods Medical records of male patients submitted to one-stage reconstruction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2±7 years were treated at our institution between 1999-2013.Results 2 5 Conclusions One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies.
Highlights
The surgical correction of bladder exstrophy remains challenging
Afterwards, in 1970s it evolved to a staged repair, with early ibju | One - staged reconstruction of bladder exstrophy pelvic ring approximation and abdominal wall, bladder and posterior urethral closure performed as a first stage, followed by second stage neourethroplasty and a bladder neck surgical reinforcement such as Yong-Dees-Leadbetter procedure [2]
Successful closure was achieved in 14 patients (93.3%) performing a single procedure; one patient had complete wound dehiscence and needed another reconstruction (6.7%) this patient had previous bladder closure elsewhere
Summary
The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. In 1990s, Mitchell introduced the concept of one-stage reconstruction of extrophy, where all the aforementioned procedures were performed as a single surgery comprehensive approach [3] The concept of this approach was to decrease the number of surgical procedures required to achieve continence as well as achieve early bladder neck resistance and bladder cycling [4]. This technique presented good results, it has some drawbacks such as risk of penile tissue loss and necessity of ostheotomies in older children or after failed repair
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