Surgical Treatment of Exstrophy of The Bladder With Emphasis on Neonatal Primary Closure: Personal Experience With 28 Consecutive Cases Treated at the University of Washington Hospitals From 1962 to 1977: Techniques and Results

No AccessJournal of UrologyPEDIATRIC UROLOGY: Classic Articles in Pediatric Urology1 Jul 2002Surgical Treatment of Exstrophy of The Bladder With Emphasis on Neonatal Primary Closure: Personal Experience With 28 Consecutive Cases Treated at the University of Washington Hospitals From 1962 to 1977: Techniques and Results Julian S. Ansell Julian S. AnsellJulian S. Ansell More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64893-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Of 28 consecutive previously untreated cases of exstrophy of the bladder seen from 1962 to 1977, 20 presented in the classical form, 3 had complete epispadias, 2 were cloacal, 1 had a superior vesical fissure and 2 were variants. Primary closure was attempted in all patients except a 1-year-old child with a tiny metaplastic bladder and 1 with cloacal exstrophy who died during the neonatal period. Closure was attempted as early as possible. Osteotomies were not required in 9 cases in which closure was done within 48 hours after birth. All older children had iliac osteotomies with simultaneous bladder closure. Complete epispadias is the goal of the initial stage in this multistage procedure. An attempt is made to swing the separated abdominal-perineal midline structures together, after dissection has freed the edge of the bladder and urethra from the skin and muscles. A key in the dissection is palpation of the medial edges of the symphyses pubes. Once these are exposed rectus fascia and muscle, and perineal structures are traced from them. I use 5F infant feeding tubes as ureteral stents brought out through the urethra. A feeding tube is anchored in the bladder and brought out per urethram for drainage. The bladder is closed with interrupted permanent non-reactive materials. Currently, 5-zero and 4-zero polypropylene is placed extramucosally in neonates. The same sutures close the recti and fascia. Symphyses are brought together in neonates with 2, 3-zero figure-of-8 polypropylenes. Subsequent stages, starting when the patient is about 1 year old, usually are required to correct epispadias. Most cases also require ureterovesicoplasties, herniorrhaphies and release of chordee. Of 26 patients 12 are continent, including 6 of the 19 classical cases, 2 complete epispadiacs, 2 variants and the 1 fissure. Of the classical types 9 patients are diverted and 3 are too young to evaluate. The upper tracts are better in closed than in diverted systems. References 1 : Primary closure of the exstrophied bladder. In: Current Controversies in Urologic Management. Edited by . Philadelphia: W. B. Saunders Co.1972: 235. Google Scholar 2 : Primary closure of exstrophy in the newborn: a preliminary report. Northwest Med1971; 70: 842. Google Scholar 3 : Vesical exstrophy. In: Urologic Surgery. Edited by . Hagerstown: Harper & Row, Publishers, Inc.1975: 316. Google Scholar 4 : The role of the cloacal membrane in exstrophy: the first successful experimental study. J Urol1964; 92: 659. Link, Google Scholar 5 Gross, S. D.: North American Medical Chiurgical Review, pp. 709–710, July 1859. Google Scholar 6 : The treatment of ectopia vesicae. Ann Surg1906; 44: 281. Google Scholar 7 : Plastic repair of exstrophy of bladder combined with bilateral osteotomy of ilia. J Urol1958; 79: 453. Google Scholar 8 : Functional closure of the bladder in children with exstrophy: a report of twenty-eight cases. J Urol1960; 83: 647. Link, Google Scholar 9 : Preliminary report: a new concept of abdominal closure in infants with exstrophy of the bladder. J Urol1962; 87: 823. Link, Google Scholar 10 : Changing trends in the management of exstrophy of the bladder. Surgery1957; 42: 61. Google Scholar 11 : The incidence treatment of ectopia vesicae. Proc Roy Soc Med1961; 54: 389. Google Scholar 12 : A Practical Treatise on the Diseases, Injuries and Malformations of the Urinary Bladder. Prostate Gland and the Urethra. Philadelphia: H. C. Lea1876. Google Scholar 13 : Exstrophy of the urinary bladder: discussion of anatomic principles applicable to its repair, with a preliminary report of a case. Minn Med1952; 35: 654. Google Scholar 14 : Congenital epispadias with incontinence. J Urol1949; 62: 513. Link, Google Scholar 15 : Functional closure of typical exstrophy of the bladder. J Urol1970; 104: 205. Link, Google Scholar 16 : Exstrophy closure: a followup on 70 cases. J Urol1966; 95: 356. Link, Google Scholar 17 Duckett, J.: Personal communication. Google Scholar 18 : The surgical treatment of epispadias. Surg Gynec Obst1963; 117: 465. Google Scholar 19 : Recurrent urosepsis in children. J Urol1961; 86: 554. Link, Google Scholar 20 : Megaureter. Brit J Urol1957; 29: 416. Google Scholar From the Department of Urology, University of Washington, Seattle, Washington© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 168Issue 1July 2002Page: 214-217 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.MetricsAuthor Information Julian S. Ansell More articles by this author Expand All Advertisement PDF downloadLoading ...