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Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique.

Elsayed ER, Alam MN, Sarhan OM, Elsayed D, Eliwa AM, Khalil S - Arab J Urol (2011)

Bottom Line: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months).Of these patients, three had recurrent exstrophy while 10 were operated primarily.It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

ABSTRACT

Objective: To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy.

Patients and methods: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure.

Results: For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later.

Conclusions: Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

No MeSH data available.


Related in: MedlinePlus

Preoperative view of a 7-month-old boy with failed exstrophy closure after fixation of two ureteric stents.
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f0005: Preoperative view of a 7-month-old boy with failed exstrophy closure after fixation of two ureteric stents.

Mentions: This prospective study, carried out between January 2006 and February 2010, included 15 patients (age range 3–47 months; 13 boys and 2 girls). Three patients had recurrent exstrophy while 12 were operated primarily; an elective surgical technique was used for all patients, of any age once osteotomy is indicated. After general anaesthesia was established, the ureteric orifices were cannulated (Fig. 1), the skin around the exstrophic bladder was incised and the exstrophic bladder was dissected from the abdominal wall extraperitoneally, with generous bladder dissection and any inter-symphyseal bands resected. The bladder was closed in two layers with insertion of a suprapubic catheter, and the epispadiac urethra reconstructed over 10 F urethral catheter using the Cantwell–Ransley technique [18]. In girls the bladder was separated from the anterior vaginal wall to help in female urethral reconstruction. Attention was directed after that to the pelvic osteotomy, in which both crura were dissected from their attachment to the inferior pubic wing. The technique of anterior pelvic osteotomy was the same as described by Frey and Cohen [15].


Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique.

Elsayed ER, Alam MN, Sarhan OM, Elsayed D, Eliwa AM, Khalil S - Arab J Urol (2011)

Preoperative view of a 7-month-old boy with failed exstrophy closure after fixation of two ureteric stents.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150575&req=5

f0005: Preoperative view of a 7-month-old boy with failed exstrophy closure after fixation of two ureteric stents.
Mentions: This prospective study, carried out between January 2006 and February 2010, included 15 patients (age range 3–47 months; 13 boys and 2 girls). Three patients had recurrent exstrophy while 12 were operated primarily; an elective surgical technique was used for all patients, of any age once osteotomy is indicated. After general anaesthesia was established, the ureteric orifices were cannulated (Fig. 1), the skin around the exstrophic bladder was incised and the exstrophic bladder was dissected from the abdominal wall extraperitoneally, with generous bladder dissection and any inter-symphyseal bands resected. The bladder was closed in two layers with insertion of a suprapubic catheter, and the epispadiac urethra reconstructed over 10 F urethral catheter using the Cantwell–Ransley technique [18]. In girls the bladder was separated from the anterior vaginal wall to help in female urethral reconstruction. Attention was directed after that to the pelvic osteotomy, in which both crura were dissected from their attachment to the inferior pubic wing. The technique of anterior pelvic osteotomy was the same as described by Frey and Cohen [15].

Bottom Line: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months).Of these patients, three had recurrent exstrophy while 10 were operated primarily.It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

ABSTRACT

Objective: To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy.

Patients and methods: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure.

Results: For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later.

Conclusions: Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

No MeSH data available.


Related in: MedlinePlus