One – staged reconstruction of bladder exstrophy in male patients: long – term follow-up outcomes

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Vol. 43 (1): 155-162, January – February, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0581


ORIGINAL ARTICLE

Amilcar Martins Giron 1, Marcos Figueiredo Mello 1, Paulo Afonso Carvalho 1, Paulo Renato Marcelo Moscardi 1, Roberto Iglesias Lopes 1, Miguel Srougi 1

1 Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil

ABSTRACT

Introduction: The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant.

Objective: To present our experience of our modified one-stage reconstruction of bla­dder exstrophy in male patients.

Materials and Methods: Medical records of male patients submitted to one-stage re­construction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2±7 years were treated at our institution between 1999-2013.

Results: Eleven patients were referred to us after previous surgery. Sixteen procedu­res were performed; one patient had complete wound dehiscence and needed another reconstruction (6.7%). Mean follow up was 10.3±4.5 years. No patient has had a loss of renal function. Postoperative complications: four patients (26.6%) presented small fistulas, one presented penile rotation. Eleven patients (73.3%) patients underwent bladder-neck surgery. Five (33.3%) required bladder augmentation. Three cases (20%) needed subsequent treatment of VUR.

At the time of our review nine (60%) patients achieved UC, two (13.3 %) patient without additional procedure. A mean of 3±1.1 procedures (2-5) was accomplished per children.

Conclusions: One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies.

 Keywords:  Bladder Exstrophy; Reconstructive Surgical Procedures; Male; Patients

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