PubMed · 7983333
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J Lepercq, P Landowski, M Tournaire, B J Paniel. 1994. [Bladder exstrophy and pregnancy].. https://pubmed.ncbi.nlm.nih.gov/7983333/
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The criteria for evaluation of urinary diversion procedures in children must be strict since their life expectancy is long. Our experience with the modified rectal bladder in children with considerable follow-up periods is reported herein. All patients were continent by day and night. Urography studies revealed a normal upper tract in all cases. Three early complications were encountered among patients who had a submucous tunnel reimplantation. Reflux to the proximal colon or the kidneys was not demonstrated. The metabolic status and growth-rate patterns of these patients were within normal limits without alkaline therapy. All urine samples aspirated from the renal pelves were sterile. We conclude that a modified rectal bladder with a second ileal intussusception valve is the operation of choice whenever urinary diversion in children is indicated.
Six patients (average age, 2 1/2 years; range, 4 months to 8 years) with the exstrophy-epispadias complex and isolate epispadias were treated using an alternative method. An inverted U-shaped incision (with a length of approximately 3 to 5 cm and a width of approximately 0.7 to 1.0 cm) was prepared, extending from the penopubic urethral meatus toward the umbilicus. The two incisions were extended along the urethral plate toward the ventral face of the glans. The pubic flap was prepared from the skin or scar tissue on the pubic area. The neourethra was reconstructed using penopubic flaps. A fistula occurred in one patient, which healed spontaneously. The penopubic flaps enabled us to form a wide-enough urethral tube and to perform a better dissection on the pubic area.
OBJECTIVES: To define the possible cause of failure and the eventual potential of the bladder in 23 exstrophy patients, who underwent more than two failed prior attempts at closure. METHODS: Twenty-three patients were selected from the exstrophy data base who had two or more prior closures. Eighteen patients had undergone 2 previous closures and 5 patients 3 previous closures for either complete dehiscence or significant prolapse. At the time of initial closure, 19 patients did not have an osteotomy. At secondary closure, 10 underwent osteotomy while at third closure 5 had an osteotomy. At the time of reclosure at our institution all underwent an osteotomy. RESULTS: Reoperative repair at our institution was successful in all patients. Six patients achieved a bladder size suitable for bladder neck reconstruction and of them 3 are dry. The bladder size was inadequate in 9 patients and 8 are being monitored for possible bladder growth. CONCLUSIONS: Tension-free closure with osteotomy and immobilization are important factors both in an initial or any subsequent closure. The chance of obtaining an adequate bladder capacity for bladder neck plasty and eventual continence, following multiple reclosures, is markedly diminished.