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1.
Urologiia ; (6): 122-125, 2020 Dec.
Artigo em Russo | MEDLINE | ID: mdl-33377690

RESUMO

Bladder exstrophy is a complex of urogenital malformations, varying in severity from epispadias to classical bladder exstrophy. The main aim of correcting bladder exstrophy in childhood is to achieve urine continence with the prevention of upper urinary tract disorders and to provide penile reconstruction. However, by the time of puberty, it is not always possible to achieve optimal anatomical features of the penis, and usually, by the end of puberty, the penile length is no more than 7 cm, which subsequently leads to psychosocial and sexual problems during puberty. Neither patient, nor urologist in most cases do not satisfy final result of the treatment of exstrophy and a number of epispadias forms. A clinical case of the surgical rehabilitation of a patient after undergoing multi-stage surgical treatment for a congenital malformation of the genitourinary system is presented in the article. MATERIALS AND METHODS: At the admission, the size of the penis was 3 cm (microfallia), urethral meatus was located in the area of the penoscrotal junction. From 2016 to 2019, the patient underwent neofallos formation, urethroplasty, and implantation of prostheses in the neophallos. RESULTS: According to the results, urinary and sexual function was completely restored, as well as anatomical relationships and dimensional parameters of the genitals.


Assuntos
Extrofia Vesical , Epispadia , Extrofia Vesical/cirurgia , Criança , Epispadia/cirurgia , Humanos , Masculino , Pênis/cirurgia , Uretra
2.
Arch Esp Urol ; 73(9): 813-818, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144535

RESUMO

OBJECTIVE: The exstrophy-epispadias complex (EEC) ranges from distal epispadias to cloacal exstrophy, with serious repercussions on the quality of life of patients. However, reconstructive surgery offers the opportunity to reach adulthood and consider motherhood.The objective of this work is to assess the uro-gynecological characteristics and the risks that pregnant women have with EEC. MATERIALS AND METHOD: Retrospective study of 50 patients diagnosed with EEC and treated in a reference center for this pathology, born between 1968 and 2000. Their medical records were reviewed and all demographic, pathological and gynecological data were collected. RESULTS: 37 patients have the inclusion criteria and of these 8 achieved 17 pregnancies (90% spontaneous and 10% through IVF). 10 were successful (50% at term) and 7 were abortions, 87.5% of which were in the first trimester. Urinary tract infection (UTI) was the most frequent complication (41.6%) and the most severe was intestinal occlusion. None of the patients presented renal function impairment during the gestation or dilation of the pathological upper urinary tract (UUT). 62.5% of the patients presented genital prolapses after pregnancies, 80% of which were grade III and IV. 87.5% were dry in the follow-up after their pregnancies. CONCLUSION: Pregnancy in the EEC patients is high risk and it is crucial that the follow-up is carried out by a specialized and integrated multidisciplinary team to minimize complications.


Assuntos
Extrofia Vesical , Epispadia , Adulto , Extrofia Vesical/cirurgia , Feminino , Humanos , Gravidez , Gravidez de Alto Risco , Qualidade de Vida , Estudos Retrospectivos
5.
Clin Imaging ; 67: 55-57, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32516694

RESUMO

Congenital pelvic anomalies include disorders of both the urinary and reproductive tracts. These disorders often coexist due to the overlapping embryological development of both systems. Magnetic resonance imaging (MRI) is a useful tool for characterization of the reproductive tract and can play an important role in the preoperative evaluation of patients with known bladder exstrophy. Accurate delineation of reproductive tract anomalies is critical as it can influence the surgical approach and can have implications for fertility. Here, we present a case of a 50-year-old female with uterine didelphys and congenital bladder exstrophy, which is an uncommon association. Our case is unique as the MR appearance of bladder exstrophy with concurrent uterine didelphys has not been reported. Additionally, this represents the first reported example of congenital herniation of both horns of the didelphys uterus through the mons pubis in the setting of bladder exstrophy.


Assuntos
Extrofia Vesical/diagnóstico por imagem , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Extrofia Vesical/complicações , Extrofia Vesical/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pelve , Prolapso , Útero/diagnóstico por imagem
6.
Cir Pediatr ; 33(2): 75-78, 2020 Apr 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32250070

RESUMO

INTRODUCTION: The success of primary bladder closure in bladder exstrophy (BE) is the determining factor for future capacity and continence. In recent years, owing to the unsatisfactory results of staged repair, complete delayed primary reconstruction has gained prominence. OBJECTIVE: To analyze short-term results in male patients with BE undergoing delayed primary closure and compare them with early bladder closure as part of staged repair in our healthcare facility. MATERIALS AND METHODS: The success of bladder closure, postoperative management, complications, and hydronephrosis was assessed over a 12-month follow-up period in both groups: early primary closure (group A) and delayed primary closure (group B). RESULTS: In group A (n=13), mean age at closure was 25 hours and mean pubic diastasis was 32 mm. Patients had respiratory support and muscle relaxation for an average of 4 days postoperatively. Closure success was 85%, and 1 patient presented maintained hydronephrosis beyond the first 6 months. In group B (n=6), mean at closure was 58 days, and mean pubic diastasis was 34 mm. Patients had epidural analgesia and no respiratory support postoperatively. Closure success was 100%. 33% had transient hydronephrosis, and 1 patient (17%) presented maintained bilateral hydronephrosis. The same immobilization technique was used in both groups for 3 weeks. CONCLUSIONS: Delayed primary reconstruction is safe as it allows for closure success without increasing complications as compared to staged repair. A long-term follow-up is required to assess urinary continence, esthetic results, and genital functionality.


Assuntos
Extrofia Vesical/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Humanos , Hidronefrose/diagnóstico , Lactente , Recém-Nascido , Masculino , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Dados Preliminares , Diástase da Sínfise Pubiana/patologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
7.
Cir. pediátr ; 33(2): 75-78, abr. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-190845

RESUMO

Introducción: El éxito del cierre primario vesical en la extrofia (EV) es el factor determinante de la capacidad y continencia futuras. En los últimos años, debido a los resultados poco satisfactorios de la reparación por estadios, la reconstrucción primaria completa diferida ha adquirido mayor protagonismo. Objetivo: Analizar los resultados a corto plazo en varones con EV sometidos a cierre primario diferido y compararlos con el cierre vesical precoz en la reparación por estadios en nuestro centro. Material y métodos: Evaluamos el éxito del cierre vesical, el manejo postoperatorio, las complicaciones y la presencia de hidronefrosis durante un tiempo de seguimiento de 12 meses en los grupos: cierre primario precoz (grupo A) y diferido (grupo B). Resultados: En el grupo A (n = 13) la edad media al cierre fue de 25 horas y la diástasis púbica media de 32 mm. Permaneció con asistencia respiratoria y relajación muscular una media de 4 días en el postoperatorio. El éxito del cierre fue del 85% y un paciente mantuvo hidronefrosis más allá de los 6 primeros meses. En el grupo B (n = 6), la edad media al cierre fue de 58 días, la diástasis púbica de 34 mm y se mantuvieron en el postoperatorio con analgesia epidural, sin asistencia respiratoria. El éxito del cierre fue del 100%, el 33% presentó hidronefrosis transitoria y un paciente (17%) hidronefrosis bilateral mantenida. En ambos grupos se empleó igual inmovilización durante 3 semanas. Conclusiones: La reconstrucción primaria diferida es segura, permitiendo el éxito del cierre sin aumentar las complicaciones, comparado con la reparación por estadios. Es necesario un seguimiento a largo plazo para evaluar la continencia urinaria, el resultado estético y la funcionalidad genital


Introduction: The success of primary bladder closure in bladder exstrophy (BE) is the determining factor for future capacity and con-tinence. In recent years, owing to the unsatisfactory results of staged repair, complete delayed primary reconstruction has gained prominence. Objective: To analyze short-term results in male patients with BE undergoing delayed primary closure and compare them with early blad-der closure as part of staged repair in our healthcare facility.Materials and methods. The success of bladder closure, postop-erative management, complications, and hydronephrosis was assessed over a 12-month follow-up period in both groups: early primary closure (group A) and delayed primary closure (group B). Results: In group A (n =13), mean age at closure was 25 hours and mean pubic diastasis was 32 mm. Patients had respiratory support and muscle relaxation for an average of 4 days postoperatively. Closure success was 85%, and 1 patient presented maintained hydronephrosis beyond the first 6 months. In group B (n = 6), mean at closure was 58 days, and mean pubic diastasis was 34 mm. Patients had epidural anal-gesia and no respiratory support postoperatively. Closure success was 100%. 33% had transient hydronephrosis, and 1 patient (17%) presented maintained bilateral hydronephrosis. The same immobilization technique was used in both groups for 3 weeks. Conclusions: Delayed primary reconstruction is safe as it allows for closure success without increasing complications as compared to staged repair. A long-term follow-up is required to assess urinary continence, esthetic results, and genital functionality


Assuntos
Humanos , Masculino , Recém-Nascido , Procedimentos Cirúrgicos Reconstrutivos/métodos , Extrofia Vesical/cirurgia , Hidronefrose , Resultado do Tratamento , Seguimentos , Estudos Retrospectivos , Fatores de Tempo
8.
J Urol ; 204(1): 136-143, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31957550

RESUMO

PURPOSE: We report the natural history and prognosis of tumors after augmentation enterocystoplasty, with a molecular analysis using an oncogene panel to search for potential targeted therapies. MATERIALS AND METHODS: This multicenter, nationwide, retrospective study included 16 patients. A panel of 21 clinically relevant oncogenes was tested on archival tumor specimens using next-generation sequencing. Survival rate was the main clinical outcome and sequences were compared to the reference genome for the genetic outcome. RESULTS: Augmentation enterocystoplasties were performed mainly for congenital neurogenic bladder and bladder exstrophy at a median patient age of 17 years (range 4 months to 45 years). Most of the malignancies were diagnosed because of clinical manifestations, with a median latency period of 20 years. Adenocarcinomas were mainly found after gastrocystoplasty, whereas urothelial cell carcinomas were typically found after colocystoplasty. Of the 16 patients 13 were diagnosed at an advanced stage of the disease (positive lymph nodes in 7, distant metastases in 6). The overall 1-year survival rate was 56%. Only 3 patients remained disease-free at a median followup of 70 months. Of the 9 tumors with analyzable DNA 4 were wild-type and 5 harbored missense mutations (KIT-p.Pro573Ser, PDGFRA-p.Glu587Lys, KRAS-p.Gly12Asp, ERBB4p.Arg484Lys, CTNNB1-p.Ser37Phe and p.Ser47Asn). CONCLUSIONS: Malignancy after augmentation enterocystoplasty is diagnosed late with frequent metastases and a very low 1-year survival rate. More than half the tested samples harbored missense mutations in oncogenes accessible to targeted therapies. An international collaboration to enlarge the genetic panel analysis of these tumors may offer new therapeutic hope to patients.


Assuntos
Oncogenes/genética , Neoplasias da Bexiga Urinária/mortalidade , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adolescente , Adulto , Extrofia Vesical/cirurgia , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Criança , Análise Mutacional de DNA , Feminino , França , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Mutação de Sentido Incorreto , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinaria Neurogênica/congênito , Bexiga Urinaria Neurogênica/cirurgia , Adulto Jovem
9.
Urology ; 136: 231-237, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31730942

RESUMO

OBJECTIVE: To describe the use of additional tissue recruited for coverage after penile lengthening in male exstrophy-epispadias complex patients using either local skin from tissue expansion (TE) or extragenital skin with a skin graft (SG) and report their respective outcomes. METHODS: An institutionally approved database of exstrophy-epispadias complex patients was retrospectively reviewed for male patients who received penile reconstruction. This included a penile lengthening procedure and the subsequent use of TE and/or a full thickness skin graft to provide cutaneous coverage of gained corporal length. RESULTS: A total of 50 patients (mean age 18.1 years) underwent penile reconstruction. TE was used in 27 patients, SG in 19, and 4 received a combination of TE and SG. The mean number of previous penile operations was 2.7 for patients that received TE and 3.1 for SG. A successful outcome from primary reconstruction was achieved in 35 patients (70%) and overall successful reconstruction was achieved by 48 patients (96%). CONCLUSION: TE and SG are useful techniques in providing soft tissue coverage following penile lengthening. TE is the preferred technique for primary reconstruction in a lengthening procedure. When genital skin is not expandable or coverage from TE is insufficient after lengthening, extragenital skin (SG) is recruited.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Pênis/cirurgia , Transplante de Pele , Expansão de Tecido , Adolescente , Adulto , Criança , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
11.
J Urol ; 203(1): 200-205, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31437120

RESUMO

PURPOSE: We investigated surgical approaches to urinary incontinence and long-term continence outcomes after successful bladder reconstruction in a heterogeneous patient population with classic bladder exstrophy. We hypothesized that while most patients will achieve urinary continence after surgery, only a select group will void volitionally per urethra. MATERIALS AND METHODS: An institutional database of 1,323 patients with exstrophy-epispadias complex was reviewed for patients with classic bladder exstrophy who underwent successful bladder closure and a subsequent continence procedure between 1975 and 2017. Procedures included bladder neck reconstruction, bladder neck reconstruction with augmentation cystoplasty or continent catheterizable stoma, and bladder neck closure with continent catheterizable stoma. Cloacal exstrophy, epispadias and variant exstrophy cases were excluded from analysis. Continence at last followup was defined as a dry interval of 3 or more hours without nighttime leakage. Those patients with more than 3 months of followup were assessed. RESULTS: Overall 432 patients underwent successful bladder closure (primary 71.5%, repeat 28.5%) and a urinary continence procedure. At last followup 162 (37%) underwent bladder neck reconstruction, 76 (18%) underwent bladder neck reconstruction with augmentation cystoplasty or continent catheterizable stoma, 173 (40%) underwent bladder neck closure with continent catheterizable stoma and 18 underwent other procedures. Median followup from the first continence procedure was 7.2 years (IQR 2.3-13.7). Continence was assessed in 350 patients. After isolated bladder neck reconstruction 91 of 142 patients were continent (64%, 95% CI 56-72). After bladder neck closure with continent catheterizable stoma 124 of 133 patients evaluated were continent (93%, 95% CI 87-97). CONCLUSIONS: Most patients with classic bladder exstrophy require multiple reconstructive procedures to achieve continence. Only about 25% of patients are expected to void normally per urethra without reliance on catheterization or urinary diversion.


Assuntos
Extrofia Vesical/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino
12.
Urology ; 137: 146-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887351

RESUMO

OBJECTIVE: To explore a series of classic bladder exstrophy (CBE) cases referred to the authors' institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. The penile disassembly technique is frequently combined with bladder closure in patients with CBE undergoing the complete primary repair of exstrophy (CPRE). Penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. METHODS: A prospectively-maintained institutional database of 1337 exstrophy-epispadias complex patients was reviewed for CPRE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. RESULTS: One hundred and thirteen male CBE patients were referred after prior CPRE. Twenty-six (20%) were identified with penile loss and reviewed. Eighty-one percent were closed in the neonatal period, and 54% had a pelvic osteotomy. Median follow-up time was 9.9 years (range 0.6-21.3). Of 26 patients with penile loss, 77% had unilateral loss and in 23% had bilateral loss involving the glans and/or one or both corpora cavernosa. Three patients were successfully managed with myocutaneous neophalloplasty. CONCLUSION: Complete penile disassembly during bladder exstrophy closure may lead to penile injury. This major complication questions the continued application of complete penile disassembly in the reconstruction of bladder exstrophy.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Complicações Intraoperatórias , Doenças do Pênis , Pênis , Procedimentos Cirúrgicos Urológicos , Atrofia , Criança , Humanos , Recém-Nascido , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/irrigação sanguínea , Pênis/lesões , Pênis/patologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
14.
Pediatr Surg Int ; 35(11): 1317-1325, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31388752

RESUMO

INTRODUCTION: It is believed that the main factors enhancing security of the bladder exstrophy closure are use of osteotomy, pubic bones approximation or transferred flaps for rectus fascia closure. However, these methods increase operating time, surgical trauma and carry risks for the patient. OBJECTIVES: To demonstrate that the goal of secure bladder exstrophy closure can be achieved easier technically and safer for the child than previously thought. The paper examines the hypothesis that less invasive bladder exstrophy closure achieved without fascia closure can reduce pain and avoid the need for immobilization and prolonged analgesia. STUDY DESIGN: Patients aged 34 days to 15 years (n = 36) from 37 who consecutively referred to the institution with classical bladder exstrophy between 2004 and 2016 underwent modified delayed primary (25) or redo (11) closure. One boy with low weight was excluded. Patient and treatment features were analysed to determine needs for immobilisation and anaesthesia in the postoperative period, and outcomes. PROCEDURE: Bladder exstrophy closure with proximal urethroplasty was performed with the detachment of crura from the ishiopubic rami and levators-from obturator internus muscle. Abdominal wall closure was accomplished with skin and subcutaneous fat mobilisation without rectus fascia closure. No method of immobilization was applied. RESULTS AND LIMITATIONS: Bladder closures have been successful in all 36 children in this report after 37 months (22-138) follow up. The surgeries took time between 126 and 215 min (mean - 148). After 1 day in the ICU the majority of the patients (34/36) were returned to the ward. No bladder spasms or signs of acute pain were noted in the ward; therefore, no local anesthesia or opioids were needed. Intravenous analgesia with non-narcotic analgesics was used for all patients in the ward for an average period 2.2 days (95% CI 2-4 days). COMPLICATIONS: Minor complications: two fistulas, which closed spontaneously; three bladder outlet obstructions, each required one endoscopic incision. No major complications of exstrophy closure such as dehiscence or bladder prolapse were occurred. CONCLUSIONS: The proposed less invasive technique with relieved postoperative program is the way to obtain successful bladder exstrophy closure as well as to reduce some risks for the patients. Absence of major complications, and avoiding the need for immobilisation and prolonged analgesia, contribute to the benefits of this approach.


Assuntos
Extrofia Vesical/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Parede Abdominal/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos
15.
Curr Urol Rep ; 20(9): 48, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286274

RESUMO

PURPOSE OF REVIEW: The exstrophy-epispadias complex (EEC) represents a group of congenitally acquired malformations involving the musculoskeletal, gastrointestinal, and genitourinary systems. Classic bladder exstrophy (CBE) is the most common and best studied entity within the EEC. In this review, imaging features of CBE anatomy will be presented with surgical correlation. RECENT FINDINGS: Magnetic resonance imaging (MRI) has emerged as a useful modality for pre- and postnatal assessment of the abdominal wall, pelvic floor, and gastrointestinal and genitourinary systems of children with CBE. The authors' experience supports use of preoperative MRI, in conjunction with navigational software, as a method for identifying complex CBE anatomy. Imaging facilitates surgical approach and improves visualization of complex anatomy, potentially helping to avoid complications. Continued investigation of imaging guidance in CBE repair is needed as surgical techniques improve.


Assuntos
Extrofia Vesical/diagnóstico por imagem , Extrofia Vesical/cirurgia , Epispadia/diagnóstico por imagem , Epispadia/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Urológicos
16.
Urology ; 131: 220-222, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176738

RESUMO

Duplicated bladder exstrophy is an extremely rare variant of the exstrophy/epispadias complex. Duplicated exstrophy defines an exstrophic mucosal plate in hypogastric area with a normal closed bladder. We present a unique case of an anteroposterior duplicated exstrophy in a female newborn.


Assuntos
Extrofia Vesical/patologia , Extrofia Vesical/classificação , Extrofia Vesical/cirurgia , Feminino , Humanos , Lactente
17.
Urology ; 131: 211-216, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176739

RESUMO

OBJECTIVE: To compare the surgical subspecialties performing bladder exstrophy closures and characterize their practice patterns using both a national and institutional database. METHODS: The National Surgical Quality Improvement Program Pediatric (NSQIPP) database was reviewed for all bladder exstrophy closures performed from 2012 to 2017. A single institutional exstrophy-epispadias complex database of 1337 patients was reviewed for patients with a bladder closure at a referring institution from 1975 to 2018. Patients with cloacal exstrophy were excluded. The subspecialties of the surgeons performing the closures were identified. Practice patterns such as the use of a pelvic osteotomy and postoperative immobilization, and perioperative outcomes were compared for each subspecialty group. RESULTS: A total of 84 bladder exstrophy patients from NSQIPP and 263 from the author's institutional database met the inclusion criteria. From NSQIPP, 88% of closures were performed by pediatric urologists while 12% were done by other subspecialists. From the institutional database, 75% of referred bladder exstrophy closures were done by a pediatric urologist, and 25% by other services. Gender, race, operation time, length of stay, and postoperative complications were not significantly different between the groups. In one database, pediatric surgeons performed closures earlier, and in another database, pediatric urologists had greater utilization of osteotomy with different immobilization techniques. Pediatric urologists had a higher success rate. CONCLUSION: Pediatric urologists performed the most bladder exstrophy closures in both databases; they operated on more delayed closures with a greater use of adjunctive procedures and a higher success rate. Differences in surgical training may contribute to the differences in practice patterns.


Assuntos
Extrofia Vesical/cirurgia , Padrões de Prática Médica/normas , Especialidades Cirúrgicas , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos
18.
J Pediatr Surg ; 54(11): 2408-2412, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31079865

RESUMO

PURPOSE: Due to the large abdominal defect from the omphalocele and extreme pubic diastasis in cloacal exstrophy (CE), bioprosthetic material may be used to bridge this gap during abdominal closure in CE. This study examined presurgical factors associated with the use of bioprosthetic materials in CE closure and complications in these patients. METHODS: An institutional database of exstrophy-epispadias complex patients was reviewed for CE. Inclusion criteria included CE and primary closure performed at the host institution from 1998 to 2018. Data collection included demographics, presurgical factors, use of bioprosthetic material, complications, and outcomes. RESULTS: All 32 patients had a staged closure and pelvic osteotomy prior to bladder closure. Ten of the 32 patients incorporated a bioprosthetic material during abdominal wall closure. There is at least 3 months follow up for all patients, all had successful bladder closure without any postoperative hernias. Those who underwent closure without bioprosthetic material were younger at the time of closure (565 vs 693 days, p = 0.043). The differences in complication rates and mean pubic diastasis was not statistically significant, p = 0.079 and p = 0.457 respectively. CONCLUSIONS: The use of bioprosthetic material is associated with older age at abdominal wall and bladder closure. The use of bioprosthetic material is a useful adjunct for secure abdominal wall closure in the reconstruction of CE. TYPE OF STUDY: Prognostic. LEVEL OF EVIDENCE: III.


Assuntos
Abdominoplastia/métodos , Anus Imperfurado/cirurgia , Bioprótese , Extrofia Vesical/cirurgia , Hérnia Umbilical/cirurgia , Escoliose/cirurgia , Anormalidades Urogenitais/cirurgia , Parede Abdominal/cirurgia , Pré-Escolar , Epispadia/cirurgia , Feminino , Humanos , Lactente , Masculino , Osteotomia , Estudos Retrospectivos
19.
J Pediatr Surg ; 54(9): 1761-1765, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31003729

RESUMO

INTRODUCTION: A successful abdominal wall and bladder closure is critical in the management of cloacal exstrophy (CE). This study examines closure outcomes and practices over the last 4 decades at the authors' institution. Beginning in 1995, the authors' institution standardized CE closure and management with the Dual-Staged Pathway (DSP). The DSP consists of a staged bladder closure, a staged or concurrent osteotomy, and postoperative immobilization with external fixation. The authors hypothesize that the DSP has provided better outcomes in CE closures. METHODS: A prospective database of 1332 Exstrophy-Epispadias Complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. The DSP consists of a staged osteotomy and a staged bladder closure in CE patients with a diastasis greater than 4 cm. To evaluate the DSP, outcomes of closure at the authors' institution were compared between two equal, twenty-year periods before and after its implementation. Data on timing of closure, postoperative management, surgical complications, and outcomes were collected. RESULTS: There are 142 CE patients in the database. In this study, 49 CE patients with 50 closures met inclusion criteria. The overall success rate of closures from 1975 to 1994 was 88% (14 of 16), while the success rate of the DSP was 100% (n = 34), p = 0.098. Twenty-two (65%) primary and 12 (35%) secondary closures were performed using the DSP. Overall complication rates of the DSP remained similar to previous closures, (29% vs 19%, p = 0.508). Since incorporation of the DSP, patients referred for closure have generally had a larger preclosure diastasis (7.2 cm vs 5.1 cm, p = 0.011). CONCLUSION: The standardized DSP closure has proven successful in 34 primary and reoperative cloacal closures in the past 20 years. With this approach, the authors feel that the DSP offers greater patient safety and better outcomes. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Extrofia Vesical/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Estudos Retrospectivos
20.
J Pediatr Orthop B ; 28(3): 207-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30830014

RESUMO

Bladder exstrophy is a congenital and rare malformation of the lower abdominal wall with exposure of the bladder mucosa to the external environment, and it is related to pelvis abnormalities. Eighteen patients with bladder exstrophy were treated with bilateral oblique pelvic osteotomy in conjunction with urologic reconstruction after they were stabilized by cast. No failure of midline closure was observed (wound dehiscence or recurrence of bladder exstrophy). Follow-up showed no leg length discrepancy or problems in walking. Bilateral oblique pelvic osteotomy is a safe procedure to treat bladder exstrophy, and it results in good orthopedic and urological function.


Assuntos
Extrofia Vesical/diagnóstico por imagem , Extrofia Vesical/cirurgia , Osteotomia/métodos , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Cuidados Pós-Operatórios/métodos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Osteotomia/tendências , Cuidados Pós-Operatórios/tendências , Resultado do Tratamento
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