A population based analysis of continence outcomes and bladder exstrophy.

COMPLETE PRIMARY REPAIR OF EXSTROPHY

An Operation for the Cure of Incontinence Associated with Epispadias

In this chapter, modern techniques for managing the newborn with classic bladder exstrophy are discussed. Management is based on the author’s experience and on data from more than 700 patients with the bladder exstrophy-epispadias-cloacal exstrophy spectrum seen at our institution. In addition, new basic science discoveries of interest to both the general and the pediatric urologist will be discussed. The primary objectives of modern surgical management of classic bladder exstrophy are as follows: (1) to create a secure abdominal closure, (2) to reconstruct a functional and cosmetically acceptable penis in the male and to reconstruct female external genitalia in the female, and (3) to preserve urinary continence, renal function, and volitional voiding. Currently, these objectives can best be achieved with newborn primary bladder and posterior urethral closure and early epispadias repair. Reconstruction of the bladder neck is undertaken when the bladder reaches an appropriate volume for an outlet procedure and the child is ready to participate in a postoperative voiding program. In this chapter, we will limit our discussion to the early management and initial primary closure of these infants.

Detrusor Wraparound for Bladder Neck Reconstruction in Cohort of Children With Bladder Exstrophy

Long-Term Followup of Patients After Redo Bladder Neck Reconstruction for Bladder Exstrophy Complex

V04-09 UNDOUBLED BLADDER IN THE SAGITTAL PLANE WITH ONE EXSTROPHIC BLADDER: A CASE REPORT ON RECONSTRUCTIVE TECHNIQUE

Exstrophy of bladder is a rare congenital malformation of the bladder with the lack of its front wall and, consequently, the anterior abdominal wall, which is often accompanied by epispadias, inguinal hernia, prolapse of the rectum, anomalies of the upper urinary tract. Its exstrophy of bladder frequency ranges on average from 1:10 000 to 1:50 000 newborns, in boys 3-6 times more often than girls. Without surgical treatment half of children with this disorder do not live to the age of 10, and 75% die in age 15.This article describes a clinical case of a patient M., 18 years old, who was admitted to the gynecological department number 1 of the Donetsk Regional center for maternal and child health for forming of vagina. The patient had a congenital malformation of the genitourinary system in the form of bladder exstrophy, at age 2 and 5 she had reconstructing operations to form the front abdominal wall of local fabrics, made at age 7 reconstruction of bladder neck has not led to a controlled urinate. Internal genital organs with no pathology except atresia of the vagina. After careful examination, using modern laboratory, instrumental and apparatus research methods patient M. was performed laparotomy in a volume: old postoperative scar excision; formation of rectal bladder, ureterorectostomia and bringing down the sigmoid colon by Duhamel; vaginoplasty.Surveillance for 75 days after the operation showed the following results: control urination and defecation, lack of urine leakage from the anterior abdominal wall and the presence of formed vagina, improving the quality of life and patient’s reproductive plans.This considered a clinical case illustrates the high efficiency of treatment of bladder exstrophy with individual methodological approach to the selection of an adequate surgical tactics.

Techniques to Create Continence in the Failed Bladder Exstrophy Closure Patient

Minimally invasive approach as an ancillary intervention post adult primary bladder exstrophy closure: Minimizing the morbidity

Videofetoscopically assisted fetal tissue engineering: Bladder augmentation

The place of pelvic osteotomy in the modern era of bladder exstrophy reconstruction

The modern staged approach to bladder exstrophy reconstruction has undergone significant changes since it was first advocated by Jeffs and Cendron in the 1970s. Although varied surgical approaches have been tried in the bladder exstrophy condition, the staged approach to bladder exstrophy repair has withstood the test of time. Progress continues to be made in evaluating the outcome of older types of staged reconstruction, with continuing modification and improvements in the modern approach to staged reconstruction. This treatise will update the reader on recent advances in the treatment of bladder and cloacal exstrophy.

A good bladder capacity and adequate outlet resistance determine success after staged reconstruction of bladder exstrophy (BE). Augmentation cystoplasty (AC) is an established salvage procedure to treat the small, noncompliant bladders of some of these children. In a series of 89 patients with BE treated over the last 12 years, 19 underwent detubularized augmentation colocystoplasty (ACC) as an adjunctive procedure. Nine underwent ACC at the time of bladder-neck reconstruction (BNR) for small bladder capacity and poor compliance; 10 underwent ACC as a secondary procedure after BNR for persistent urinary incontinence or poor bladder compliance and upper-tract deterioration. The follow-up period ranged between 6 months and 12 years (mean 41 months). Complications included symptomatic urinary-tract infection in 4 patients, recurrent epididymo-orchitis in 2, calculi in 3, colonic anastomotic dehiscence in 1, bladder-patch fistula in 2, and secondary coloureteric-junction obstruction in 1. There was no postoperative reservoir perforation or mortality. The upper tract remained normal or stable in all patients. Nine of the 19 patients are dry both day and night; 4 others are dry during the day but have occasional nocturnal wetting. Three patients have nocturnal wetting with stress incontinence and 2 remain incontinent. Seven patients can void effectively using abdominal contractions and 12 require clean intermittent catherization to ensure complete voiding. The indications and results of AC in BE from other series are reviewed. AC is an important and safe adjunctive procedure in a subset of BE patients with small and poorly compliant bladders. Despite the known complications, more liberal use of AC in BE is warranted.

Cloaca, the Most Severe Degree of Imperforate Anus. Experience With 195 Cases

MP72-12 BLADDER AUGMENTATION RENDERS BILATERAL URETERIC REIMPLANTATION UNNECESSARY IN POST-INFANCY BLADDER EXSTROPHY REPAIR