Total Urogenital Complex Mobilization for Bladder Exstrophy Repair in Females

Abstract

PURPOSE Bladder exstrophy (BE) in females can be considered as a variant of urogenital sinus. As for the latter, total urogenital complex mobilization (TUM) has been proposed as an option in the surgical repair of the condition. We report on our experience with the use of the TUM in female cases of BE. MATERIAL AND METHODS Two female cases of BE underwent repair by TUM. Of the two cases, one was a primary neonatal repair and the other a secondary repair 30 days after a previous failed attempt. TUM involved mobilization of the vagina and bladder template as a single unit. The urethra was created by tabularization of the urethral plate adherent to the dorsal aspect of the vagina. The pelvic diaphragm anterior to the rectum was opened and the complex made by urethra and vagina repositioned in the proper anatomical positions deep in the perineum. The pelvic diaphragm was then reconstructed anterior to the urogenital complex. RESULTS Both BE closures were successful. TUM allowed for a proper positioning of the vagina and urethra deep in the perineum, in a tension-free manner and without any need for skin flaps. Retrusion of the urethral meatus was observed in one case for a partial dehiscence of the urethroplasty. CONCLUSIONS TUM allows for a more normal positioning of the urethra and vagaina in the anterior pelvic diaphragm during BE repair in females. This might increase the chance to achieve continence at a later age and reduce the long-term morbidity due to the horizontal orientation of the vagina.