V09-05 ASSESSMENT OF TISSUE PERFUSION USING INTRAOPERATIVE LASER ANGIOGRAPHY IN BLADDER EXSTROPHY CLOSURE

Abstract

INTRODUCTION AND OBJECTIVE: Penile reconstruction during exstrophy closure is fraught with the specter of penile loss. To date, no clear clinical method can reliably predict this rare and devastating outcome. To this end we have incorporated penile perfusion testing using intraoperative laser angiography with indocyanine green (ICG) in to our operative approach. METHODS: We describe our IRB-approved intraoperative technique of using ICG at key points during exstrophy closure. Perfusion measurements are taken at four times: 1) prior to dissection, 2) after dissection of the bladder plate and bladder neck 3) with the hips rotated inwards to approximate the pubis and 4) at the completion of the case. This inexpensive fluorescent agent provides real time measurement of tissue perfusion with the ability to redose every 15 minutes. Measurements are taken at 80 seconds post infusion and the medial thigh serves as the reference control. RESULTS: To date, six patients have been evaluated with this technique. After initial dissection blood flow does not change to any significant degree. Upon approximating the pubis, perfusion decreases by more than 50%. Patients who underwent complete primary repair of exstrophy (CPRE) experienced a greater reduction in perfusion than patients who underwent a staged approach. CONCLUSIONS: Intraoperative laser angiography is easy to employ and should be considered a reasonable adjunct to tissue assessment and operative decision making in patients undergoing closure of bladder exstrophy. Source of Funding: none