Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size.

Nastaran Sabetkish,Shabnam Sabetkish,Abdol-Mohammad Kajbafzadeh

doi:10.1590/s1677-5538.ibju.2017.0196

Abstract

ABSTRACTObjectiveTo assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstro- phy cases, and to compare the results with the application of low-barrier wrap.Materials and MethodsEight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps.ResultsThe high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps' size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC.ConclusionPolyps' size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more “exstrophy-friendly”.

Highlights

Bladder exstrophy epispadias complex (BEEC) is an uncommon congenital abnormality
3 out of 8 patients (37.5%) experienced a low grade skin allergy when low density polyethylene (LDPE) was applied in preoperative care; while no skin allergy was observed in none of the participants when the wrap was replaced with polyvinylidene chloride (PVdC) (Table-1)
The number of polyps decreased in 3 patients when LDPE was replaced with PVdC (Table-1)

Summary

Introduction

Bladder exstrophy epispadias complex (BEEC) is an uncommon congenital abnormality. The prevalence of classic bladder exstrophy is approximately 1 in 50,000 live births [1]. In these affected patients, the gross appearance of the bladder template, especially in the setting of polyp formation, is a major concern for the surgeon. Concern of premalignant lesions may rise by the polypoid manifestation of the exstrophic bladder template [2]. It should be mentioned that patients can confront with more severe epithelial injury in the presence of cystitis glandularis in polyps excised during repeat or delayed primary closure [3]

Methods

Results

Conclusion