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Li O, Lee R, Boss RD, Wang MH. Palliative Care for Pediatric Urology. J Pain Symptom Manage 2024; 68:e1-e7. [PMID: 38521421 DOI: 10.1016/j.jpainsymman.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
Palliative care in the field of urology has largely been limited to adult oncologic conditions. Although there is a plethora of established literature suggesting the advantageous impact of palliative care, there is limited integration of palliative care in adult urology. This underutilization is further exacerbated in pediatric urology, and palliative care in pediatric urology remains an underexplored area despite the prevalence of several life-limiting conditions in this patient population. This paper highlights the potential need for palliative care intervention in a variety of urologic conditions in the pediatric population, including congenital lower urinary tract obstruction, neurogenic bladder dysfunction, exstrophy-epispadias complex, and congenital bilateral renal agenesis. Each condition poses unique challenges that can be addressed with the inclusion of a palliative care team, including decision-making spanning prenatal-neonatal-pediatric periods, acute and chronic symptom management, family relations, body image issues, risk of recurrent hospitalizations and surgeries, and potentially fatal complications. Alongside standard urologic interventions, palliative care can serve as an additional means of addressing physical and psychosocial symptoms experienced by pediatric urology patients to enhance the quality of life of patients and their families.
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Affiliation(s)
- Oscar Li
- Johns Hopkins University School of Medicine (O.L., R.L.), Baltimore, Maryland, USA.
| | - Royce Lee
- Johns Hopkins University School of Medicine (O.L., R.L.), Baltimore, Maryland, USA
| | - Renee D Boss
- Department of Pediatrics (R.D.B.), Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ming-Hsien Wang
- Jeffs Division of Pediatric Urology (M.H.W.), Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Zhan J, Jia F, Gao Q, Xiao X. A case report of single umbilical artery combined with fetal bladder exstrophy in singleton pregnancy and related literature review. BMC Pregnancy Childbirth 2024; 24:122. [PMID: 38336714 PMCID: PMC10854176 DOI: 10.1186/s12884-024-06318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND According to prenatal ultrasonographic studies, single umbilical artery may be present alone or in association with other fetal abnormalities. So far, the exact pathogenesis of bladder exstrophy is unclear. Some scholars believe that bladder exstrophy and cloacal exstrophy should be regarded as a disease spectrum to explore their pathogenesis. If bladder exstrophy and cloacal exstrophy are regarded as the same disease spectrum, then we can speculate that the single umbilical artery should have the probability of being accompanied by bladder exstrophy at the same time. CASE PRESENTATION For the first time, we report a rare case of fetal bladder exstrophy with single umbilical artery in single pregnancy. This patient underwent targeted color Doppler ultrasound at 26 weeks of pregnancy which first suspected bladder exstrophy with single umbilical artery and fetal MRI for diagnosis at 38 + 3 weeks of pregnancy which confirmed the suspicion. After the diagnosis was confirmed, the patient was scheduled for a multidisciplinary discussion. Ultimately the patient opted for induced fetal demise at 38 + 5 weeks of pregnancy and the physical appearance of the fetal demise affirmed previous ultrasound and MRI examination results. CONCLUSIONS Our report is the first finding of single umbilical artery combined with bladder exstrophy in a singleton pregnancy. Accordingly, our case enhances the evidence that cloacal exstrophy and bladder exstrophy should be treated as the same disease spectrum. In addition, we conducted a literature review on the diagnostic progress of single umbilical artery combined with bladder exstrophy, hoping to provide useful references for the diagnosis of this disease.
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Affiliation(s)
- Jun Zhan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China
| | - Fenglin Jia
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qianqian Gao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xue Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China.
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Lee T, Roth E, Shukla A, Gupta N, Lee R, Kryger J, Groth T, Canning D, Mitchell M, Weiss D, Borer J. Pelvic Ectopic Kidney Prevalence and Pressure Changes During Cloacal Exstrophy (Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome) Closure. Urology 2023; 181:124-127. [PMID: 37634851 DOI: 10.1016/j.urology.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES To assess the prevalence of pelvic ectopic kidneys (PEK) and compare renal parameters of the PEK to the orthotopic kidney following pubic bone approximation. METHODS In four Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome (OEIS) patients undergoing second-stage repair with known pelvic and orthotopic kidneys, changes in the renal pelvis pressure (RPP), peak systolic velocity (PSV), and resistive index (RI) were measured in the pelvic and orthotopic kidneys following pubic bone approximation. A paired t-test was performed for analysis. Prevalence was tabulated using a multi-institutional retrospective review. RESULTS Mean rise in RPP was +26.0 mmHg in the PEK and +10.3 mmHg in the orthotopic kidney (P = .55). One patient had immediate increase in RPP of 66 mmHg in the PEK (7 mmHg in the orthotopic kidney) which decreased to +17 mmHg in the PEK upon release of the pubic approximation stitch. Mean change in PSV was +67.7 cm/s in the PEK compared to - 25.7 cm/s in the orthotopic kidney (P = .09). Mean change in renal RI was + 0.06 in PEK compared to - 0.01 in the orthotopic kidney (P = .29). Among 80 OEIS patients, 24 (30%) had a PEK. 3 (4%) had a solitary PEK. CONCLUSION During second-stage OEIS closure, we witnessed patterns of higher change in RPP, PSV, and RI of the PEK compared to the orthotopic kidney. Furthermore, PEKs were found in nearly a third of our OEIS patients. Real-time RPP monitoring, especially those with solitary PEK, may aid in the management of OEIS patients during the perioperative period.
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Affiliation(s)
- Ted Lee
- Boston Children's Hospital, Department of Urology, Boston, MA.
| | - Elizabeth Roth
- Children's Wisconsin, Department of Urology, Milwaukee, WI
| | - Aseem Shukla
- Children's Hospital of Pennsylvania, Department of Urology, Philadelphia, PA
| | - Naveen Gupta
- Boston Children's Hospital, Department of Urology, Boston, MA
| | - Richard Lee
- Boston Children's Hospital, Department of Urology, Boston, MA
| | - John Kryger
- Children's Wisconsin, Department of Urology, Milwaukee, WI
| | - Travis Groth
- Children's Wisconsin, Department of Urology, Milwaukee, WI
| | - Douglas Canning
- Children's Hospital of Pennsylvania, Department of Urology, Philadelphia, PA
| | | | - Dana Weiss
- Children's Hospital of Pennsylvania, Department of Urology, Philadelphia, PA
| | - Joseph Borer
- Boston Children's Hospital, Department of Urology, Boston, MA
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Schrey-Petersen S, Lacher M, Stepan H. Course of an unplanned and unexpected pregnancy in a 39 year-old patient with Complex bladder extrophy: a case report. J Med Case Rep 2023; 17:450. [PMID: 37898815 PMCID: PMC10613355 DOI: 10.1186/s13256-023-04181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 09/15/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND With improved operative techniques pregnancy rates have been rising in patients with anomalies of the extrophy-epispadias-complex, including also female patients with bladder extrophy. Specific risks around pregnancy need to be addressed sufficiently beforehand. CASE PRESENTATION An unplanned pregnancy was detected at 34 weeks in a 39-year old White female patient with former complex bladder extrophy. Decades after her operation she had not received any follow-up medical care and believed to be unable to conceive due to her anomaly. Thus no contraceptive matters were taken. The patient had lived in a stable relationship with regular sexual intercourse for many years. Until 34 weeks the pregnancy was uncomplicated, but then uterine prolapse and signs of beginning pre-eclampsia appeared, and a healthy girl was born with cesarean section. CONCLUSION As patients with bladder extrophy and other anomalies from the extrophy-epispadias-complex reach adolescence/adulthood, they need continuous medical follow-up and transition of care to adult surgery and gynecology in order to address specific aspects of sexual health, reproduction, contraception, and also cancer screening. In the presented case lack of transition of care resulted in an unplanned and complicated pregnancy.
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Affiliation(s)
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, Liebigstr. 20A, 04103, Leipzig, Germany
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Esmaeilizadeh AH, Ebrahimisaraj G, Sarafi M, Rouzrokh M, Mohajerzadeh L, Ghoroubi J, Tabari AK, Ebrahimian M. The outcome and complications of modern staged repair surgery in newborns with classic bladder exstrophy in different genders: A retrospective study. Birth Defects Res 2023; 115:1469-1474. [PMID: 37507850 DOI: 10.1002/bdr2.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/20/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Classic bladder exstrophy (CBE) is a rare anterior midline birth defect that remains a challenge for pediatric surgeons. Despite multiple reconstructive methods, outcomes vary widely in various reports. This study aims to compare the success rate and complications of modern staged repair of exstrophy (MSRE) in each gender and compare together. METHODS This retrospective cross-sectional study included cases of CBE between 2010 and 2020 that underwent MSRE. Short-term follow-up results, including incontinence rate, vesicoureteral reflux (VUR), urinary infections, deformed genitalia, and so on, were measured in each gender, and their differences were reported. RESULTS Among the 40 newborns with CBE who underwent MSRE, 25 (62.5%) were boys, while the others had non-male genitalia. The rates of incontinence, VUR, dehiscence, and fistulas did not differ significantly between genders. However, chronic urinary tract infections (UTIs) were more frequent in girls, and boys were more likely to have malformed genitalia (p < .05). CONCLUSION Our findings indicate a similar rate of complications in each gender. However, chronic UTIs and external genitalia deformities were significantly more common in girls and boys, respectively. Further large-sized controlled trials may be needed to corroborate these findings.
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Affiliation(s)
- Amin Haj Esmaeilizadeh
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Ebrahimisaraj
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Sarafi
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rouzrokh
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leily Mohajerzadeh
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Ghoroubi
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Khaleghnejad Tabari
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manoochehr Ebrahimian
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Calisti A, Belay K, Mombo A, Nugud FA, Salman DY, Lelli Chiesa P. Presentations of bladder exstrophy in a resource-limited setting and the role of Mainz II continent diversion for late referrals or failed primary closures: a multicentric report. LA PEDIATRIA MEDICA E CHIRURGICA 2023; 45. [PMID: 37667897 DOI: 10.4081/pmc.2023.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Primary closure techniques that have been updated and longterm follow-up for CBE (classic bladder exstrophy) may be out of reach for many patients living in resource-limited settings. Late referrals to medical care and primary closures that lack the necessary skills and facilities for comprehensive treatment are still common. Alternative and long-term surgical solutions may improve the lives of these unfortunate patients. During surgical outreach missions, patients with CBE, either non-operated or with a previous unsuccessful bladder closure, who were referred from vast under-resourced rural areas to three Eastern African hospitals, were studied. The following information is provided: mode of presentation, clinical history, diagnostic workout, management, and outcome. There were 25 cases (M/F ratio 17/8) ranging in age from two days to twenty years. Five of the seventeen patients who were not treated (35%) were under 120 days old and eligible for primary closure in a qualified tertiary center when one was available in the country. There were twelve late referred cases (ranging from 120 days to 20 years). Between the ages of ten months and twelve years, eight children arrived following a failed primary closure. In all of them, the bladder plate was too altered to allow closure. Following a preoperative diagnostic workout, a Mainz II continent internal diversion was proposed to fourteen patients with acceptable bowel control and postponed in the other three. Three cases were lost before treatment because parents refused the procedure. Twelve cases ranging in age from three to twenty years (mean seven years) were operated on. Eight people were followed for a total of 53.87 months (range: 36-120). Except for three people who complained of occasional night soiling, day and night continence were good. The average voiding frequency during the day was four and 1.3 at night. There was no evidence of a metabolic imbalance, urinary infection, or significant upper urinary tract dilatation. Two fatalities could not be linked to urinary diversion. Four patients were not followed up on. Due to the limited number of specialist surgical facilities, CBE late referral or failed closure is to be expected in a resource-limited context. In lieu of the primary closure, a continent internal diversion will be proposed and encouraged even at the level of a non-specialist hospital to improve the quality of life of these unfortunate patients. It is recommended that patients be warned about the procedure's potential long-term risks, which will necessitate a limited but regular follow-up.
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Affiliation(s)
| | - Kibreab Belay
- Department of Surgery - Orotta National Referral Hospital, Asmara.
| | - Andrea Mombo
- Department of Urology Consolata Hospital Ikonda, Njombe.
| | | | | | - Pierluigi Lelli Chiesa
- Pediatric Surgery, Santo Spirito Hospital-Pescara-University G. D'Annunzio Chieti-Pescara.
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Modekwe VI, Ekwunife OH, Ugwu JO, Ugwunne CA, Ndukwu CU, Obiegbu HO, Obidike AB. Classical bladder exstrophy in an adolescent: A case report on management, challenges and outcome. Afr J Paediatr Surg 2023; 20:233-237. [PMID: 37470562 PMCID: PMC10450118 DOI: 10.4103/ajps.ajps_172_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 01/22/2023] Open
Abstract
Classical bladder exstrophy is a congenital anomaly whose management and outcome has advanced over years. Management and outcome are better when management starts at the newborn period. This was the management of a neglected bladder exstrophy in a male presenting at 16 years of age. We report our challenges, management and outcome to highlight the rarity of this presentation, and the adaptation to the usual protocol of care. The patient presented at 16 years of age with classic bladder exstrophy. The bladder plate was contracted and had cystitis. The patient had a modification of complete primary repair of exstrophy (CPRE) with bilateral pelvic osteotomy stabilised with a 7-hole plate and 4 screws, then bladder neck reconstruction + bladder augmentation + cross-trigonal neocystoureterostomy in a 12-h procedure. He had surgical site infection, superficial wound breakdown and vesicocutaneous fistula that all healed with dressing and prolonged suprapubic cystostomy drainage. He achieved some degree of urinary continence and ability to void, though he still has stress incontinence and frequency at 6 months of follow-up. He has a micturition interval of 60-120 min, and is expected to improve. Presentation and repair of classic bladder exstrophy in the adolescent is very rare in the literature and therefore no known standard of care. This report adds to the body of knowledge. Again, this experience lends credence to the proponents of CPRE in reducing the number of procedures required to treat exstrophy.
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Affiliation(s)
- Victor Ifeanyichukwu Modekwe
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Okechukwu Hyginus Ekwunife
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Jideofor Okechukwu Ugwu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chuka Abunike Ugwunne
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chibuzo Uchechukwu Ndukwu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Orthopaedics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Henry Obinna Obiegbu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Orthopaedics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Afam Ben Obidike
- Department of Anaesthesia, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Dorjey Y. Role of ultrasound scan in prenatal diagnosis of cloacal exstrophy. Clin Case Rep 2023; 11:e7072. [PMID: 36937643 PMCID: PMC10014517 DOI: 10.1002/ccr3.7072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 02/19/2023] [Indexed: 03/17/2023] Open
Abstract
Cloacal exstrophy is a rare and complex ventral abdominal wall defect. Prenatal diagnosis is possible with the use of detailed ultrasound scanning. Prenatal diagnosis of an anomalous fetus helps the parents and their families in making informed decisions. This write-up is to report a case of cloacal exstrophy diagnosed during the prenatal period using an ultrasound scan. The pregnant mother presented at 35 weeks of gestation underwent a detailed ultrasound scanning and note the findings; a large defect on the ventral surface of the anterior abdominal wall extending from the umbilicus to the inferior pelvis, with a large mass protruding through the defect, umbilical cord arising from the proximal part of the mass, with another tubular mass protruding from the inferior aspect of the larger mass giving an appearance of "elephant trunk," absent urinary bladder, absent anal dimple, and scrotum was seen inferior to the mass but failed to appreciate the phallus. Both kidneys were normal, and there was no spinal defect. In addition, pubic bones were widely separated, and there was splaying of the iliac bone. Based on the ultrasound scan findings, a prenatal diagnosis of cloacal exstrophy was made. The pregnant mother and their families were counseled about the anomalous fetus, and they decided to continue the pregnancy. At birth, the abnormalities present in the baby were consistent with the prenatal ultrasound scan findings. On postnatal day 5, the baby underwent a complete primary surgical repair of the defect which comprised of closure of the abdominal wall defect, repair of bladder defect, pelvic osteotomies, and creation of a colostomy. The abnormalities of cloacal exstrophy detected by the ultrasound scan during the prenatal diagnosis period were consistent with the abnormalities detected at birth. This concludes that an ultrasound scan is a reliable tool to diagnose cloacal exstrophy during the prenatal period.
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Kelly JH, Taghavi K, Mushtaq I. Justin H. Kelly and his procedure for bladder exstrophy and epispadias. J Pediatr Surg 2022; 57:314-321. [PMID: 34772513 DOI: 10.1016/j.jpedsurg.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
The operations involved in the repair of complete bladder exstrophy (CBE), familiarly known as the Kelly procedure, evolved over more than 100 years. Through repeated cycles of trial and error, some of the most prominent urologists in the world developed techniques that addressed each of the formidable surgical challenges presented by CBE and epispadias. A key figure is Justin H. Kelly of the Royal Children's Hospital, Melbourne, who made surgery for CBE his life's work. He took the lessons of his surgical predecessors, giants like: Friedrich Trendelenburg, Hugh Hampton Young, John Dees, and Guy Leadbetter, applied techniques for anorectal anomalies from his contemporary Alberto Peña, and saw his procedures improved by the next generation of leaders in paediatric urology that included Phillip Ransley, Peter Cuckow, Patrick Duffy, and John Gearhart. Over his long career, Mr Kelly modified and perfected his eponymous procedure patient-by-patient through a painstaking process of trial-and-error, bearing with his young patients and their families through every heart-breaking complication, and gradually creating the standard operation for children with CBE and epispadias.
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Affiliation(s)
- Justin H Kelly
- Department of Paediatric Urology, The Royal Children's Hospital, Melbourne, Australia
| | - Kiarash Taghavi
- Department of Paediatric Urology, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Gupta AK, Gohil AJ, Lamba S. Abdominal wall closure in adult patients with untreated exstrophy of bladder. Indian J Urol 2022; 38:48-52. [PMID: 35136295 PMCID: PMC8796765 DOI: 10.4103/iju.iju_204_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/20/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Bladder exstrophy is an anomaly, which if not treated early in the age, poses a surgical challenge in providing an adequate abdominal wall closure. We report our experience in patients with untreated exstrophy of the bladder, who underwent cystectomy, ileal conduit, and abdominal reconstruction using the anterior rectus sheath turndown flap and paired inguinal skin flaps. MATERIALS AND METHODS Ten previously unoperated adult patients with exstrophy with epispadias, who underwent surgery at our institute from January 2010 till January 2021, were included in this study to evaluate the adequacy of abdominal wall closure with our technique of retrograde turndown anterior rectus sheath flap with paired inguinal flap, and to document immediate and delayed complications, especially incisional hernia. RESULTS The mean follow-up period of the study was 16.5 months. We found that our technique provided adequate local tissue for a sturdy two-layered closure of the lower abdominal wall defect. Out of the ten patients, only one required an additional flap for abdominal wound closure. There were no stoma-related complications or incisional hernia. CONCLUSION Abdominal wall reconstruction, for skin and fascial defects, in such complex cases can be performed by local skin and fascia using a relatively simple, safe, easy, and affordable technique as we have described. Our technique avoids the use of synthetic mesh, thereby reducing the chances of infection in such chronic open wounds.
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Affiliation(s)
- Ashish Kumar Gupta
- Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Affiliated to The Tamilnadu Dr M.G.R. Medical University, Chennai, Tamil Nadu, India
| | - Amish Jayantilal Gohil
- Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Affiliated to The Tamilnadu Dr M.G.R. Medical University, Chennai, Tamil Nadu, India,E-mail:
| | - Shashank Lamba
- Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Affiliated to The Tamilnadu Dr M.G.R. Medical University, Chennai, Tamil Nadu, India
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Madan AJ, Alhindi S. Treatment strategies for OIES complex/cloacal extrophy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Rieke JM, Zhang R, Braun D, Yilmaz Ö, Japp AS, Lopes FM, Pleschka M, Hilger AC, Schneider S, Newman WG, Beaman GM, Nordenskjöld A, Ebert AK, Promm M, Rösch WH, Stein R, Hirsch K, Schäfer FM, Schmiedeke E, Boemers TM, Lacher M, Kluth D, Gosemann JH, Anderberg M, Barker G, Holmdahl G, Läckgren G, Keene D, Cervellione RM, Giorgio E, Di Grazia M, Feitz WFJ, Marcelis CLM, Van Rooij IALM, Bökenkamp A, Beckers GMA, Keegan CE, Sharma A, Dakal TC, Wittler L, Grote P, Zwink N, Jenetzky E, Brusco A, Thiele H, Ludwig M, Schweizer U, Woolf AS, Odermatt B, Reutter H. SLC20A1 Is Involved in Urinary Tract and Urorectal Development. Front Cell Dev Biol 2020; 8:567. [PMID: 32850778 PMCID: PMC7426641 DOI: 10.3389/fcell.2020.00567] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023] Open
Abstract
Previous studies in developing Xenopus and zebrafish reported that the phosphate transporter slc20a1a is expressed in pronephric kidneys. The recent identification of SLC20A1 as a monoallelic candidate gene for cloacal exstrophy further suggests its involvement in the urinary tract and urorectal development. However, little is known of the functional role of SLC20A1 in urinary tract development. Here, we investigated this using morpholino oligonucleotide knockdown of the zebrafish ortholog slc20a1a. This caused kidney cysts and malformations of the cloaca. Moreover, in morphants we demonstrated dysfunctional voiding and hindgut opening defects mimicking imperforate anus in human cloacal exstrophy. Furthermore, we performed immunohistochemistry of an unaffected 6-week-old human embryo and detected SLC20A1 in the urinary tract and the abdominal midline, structures implicated in the pathogenesis of cloacal exstrophy. Additionally, we resequenced SLC20A1 in 690 individuals with bladder exstrophy-epispadias complex (BEEC) including 84 individuals with cloacal exstrophy. We identified two additional monoallelic de novo variants. One was identified in a case-parent trio with classic bladder exstrophy, and one additional novel de novo variant was detected in an affected mother who transmitted this variant to her affected son. To study the potential cellular impact of SLC20A1 variants, we expressed them in HEK293 cells. Here, phosphate transport was not compromised, suggesting that it is not a disease mechanism. However, there was a tendency for lower levels of cleaved caspase-3, perhaps implicating apoptosis pathways in the disease. Our results suggest SLC20A1 is involved in urinary tract and urorectal development and implicate SLC20A1 as a disease-gene for BEEC.
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Affiliation(s)
- Johanna Magdalena Rieke
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
- Institute for Anatomy and Cell Biology, University Hospital Bonn, University of Bonn, Bonn, Germany
- Department of Pediatrics, Children’s Hospital Medical Center, University Hospital Bonn, Bonn, Germany
| | - Rong Zhang
- Institut für Biochemie und Molekularbiologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Doreen Braun
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Öznur Yilmaz
- Institute for Anatomy and Cell Biology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Anna S. Japp
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
- Institute of Pathology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Filipa M. Lopes
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Michael Pleschka
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
- Institute for Anatomy and Cell Biology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Alina C. Hilger
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
- Department of Pediatrics, Children’s Hospital Medical Center, University Hospital Bonn, Bonn, Germany
| | - Sophia Schneider
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital Medical Center, University Hospital Bonn, Bonn, Germany
| | - William G. Newman
- Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Glenda M. Beaman
- Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Agneta Nordenskjöld
- Department of Women’s and Children’s Health, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
- Pediatric Surgery, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anne-Karoline Ebert
- Department of Urology and Pediatric Urology, University Hospital of Ulm, Ulm, Germany
| | - Martin Promm
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
| | - Wolfgang H. Rösch
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
| | - Raimund Stein
- Medical Faculty Mannheim, Centre for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Karin Hirsch
- Division of Pediatric Urology, Department of Urology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Urology, Cnopfsche Kinderklinik, Nürnberg, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Thomas M. Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children’s Hospital of Cologne, Cologne, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Dietrich Kluth
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | | | - Magnus Anderberg
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - Gillian Barker
- Department of Women’s and Children’s Health, Uppsala Academic Children Hospital, Uppsala, Sweden
| | - Gundela Holmdahl
- Department of Pediatric Surgery, Queen Silvias Children’s Hospital, Gothenburg, Sweden
| | - Göran Läckgren
- Pediatric Urology, University Children’s Hospital, Uppsala, Sweden
| | - David Keene
- Pediatric Urology, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Raimondo M. Cervellione
- Pediatric Urology, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Elisa Giorgio
- Department of Medical Sciences, University of Torino, Turin, Italy
- Medical Genetics Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Massimo Di Grazia
- Pediatric Urology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Wouter F. J. Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children’s Hospital, Nijmegen, Netherlands
| | - Carlo L. M. Marcelis
- Department of Genetics, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Iris A. L. M. Van Rooij
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arend Bökenkamp
- Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Goedele M. A. Beckers
- Department of Urology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Catherine E. Keegan
- Division of Genetics, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, United States
| | - Amit Sharma
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Tikam Chand Dakal
- Department of Biotechnology, Mohanlal Sukhadia University Udaipur, Udaipur, India
| | - Lars Wittler
- Department of Developmental Genetics, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Phillip Grote
- Institute of Cardiovascular Regeneration, Center for Molecular Medicine, Goethe University, Frankfurt am Main, Germany
| | - Nadine Zwink
- Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Ekkehart Jenetzky
- Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Alfredo Brusco
- Department of Medical Sciences, University of Torino, Turin, Italy
- Medical Genetics Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Holger Thiele
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Ulrich Schweizer
- Institut für Biochemie und Molekularbiologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Adrian S. Woolf
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Benjamin Odermatt
- Institute for Anatomy and Cell Biology, University Hospital Bonn, University of Bonn, Bonn, Germany
- Institute for Neuroanatomy, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital Medical Center, University Hospital Bonn, Bonn, Germany
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Winde F, Backhaus K, Zeitler JA, Schlegel N, Meyer T. Bladder Augmentation Using Lyoplant ®: First Experimental Results in Rats. Tissue Eng Regen Med 2019; 16:645-652. [PMID: 31824826 DOI: 10.1007/s13770-019-00209-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022] Open
Abstract
Background Congenital defects of the urinary bladder (micro- or contracted bladder, bladder exstrophy) remain a challenging problem for pediatric surgeons. Even when conservative treatment options are fully exhausted, irreversible renal dysfunction can be observed in a large number of cases that can even lead to chronic renal failure and the need for kidney transplantation. To protect kidney function bladder augmentation using intestinal tissue is commonly applied as the standard treatment method. However due to the unphysiological nature of intestinal tissue a number of problems and complications such as urinary tract infections or bladder stone formation limit the clinical success of this approach. Moreover a number of substitutes for the implementation of a bladder augmentation have been tested without success to date. Here we used an experimental model to test wether the biocompatible collagen mesh Lyoplant may be a suitable candidate for bladder augmentation. Methods We implanted a biocompatible collagen mesh (Lyoplant®) in a bladder defect rat model for bladder augmentation (Lyoplant®-group: n = 12; sham group n = 4). After 6 weeks the abdomen was reopened and the initial implant as well as the bladder were resected for histological and immunohistochemical examination. Results All but one rat exhibited physiological growth and behaviour after the operation without differences between the Lyoplant®-group (n = 12) and the sham group (n = 3). One rat from the sham group had to be excluded because of a suture leakage. No wound healing complications, wound infections and no herniation were observed. After 5 weeks the implants showed an adequate incorporation in all cases. This was confirmed by immunohistological analyses where a significant cell infiltration and neovascularization was observed. Conclusion In summary, Lyoplant® appears to be a promising tool in experimental bladder augmentation/regeneration in rats.
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Affiliation(s)
- F Winde
- 1Pediatric Surgery-, Pediatric Trauma - and Pediatric Urology Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Würzburg, Germany
| | - K Backhaus
- 1Pediatric Surgery-, Pediatric Trauma - and Pediatric Urology Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Würzburg, Germany
| | - J A Zeitler
- 2Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - N Schlegel
- 3Experimental Surgery Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University of Wuerzburg, Würzburg, Germany
| | - Th Meyer
- 1Pediatric Surgery-, Pediatric Trauma - and Pediatric Urology Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Würzburg, Germany
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Jones B, Berent AC, Weisse CW, Hart R, Alvarez L, Fischetti A, Horn BD, Canning D. Surgical and endoscopic treatment of bladder exstrophy-epispadias complex in a female dog. J Am Vet Med Assoc 2018; 252:732-743. [PMID: 29504860 DOI: 10.2460/javma.252.6.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 14-week-old 7.7-kg (16.9-lb) sexually intact female Golden Retriever was evaluated because of urine dripping from the caudoventral aspect of the abdomen. CLINICAL FINDINGS Ultrasonography, radiography, excretory CT urography, and vaginocystourethroscopy were performed. Results indicated eversion of the bladder through the ventral abdominal wall with exposure of the ureterovesicular junctions, pubic diastasis, and an open vulva and clitoral fossa. Clinical findings were suggestive of bladder exstrophy, a rare congenital anomaly. TREATMENT AND OUTCOME The dog was anesthetized and bilateral ileal osteotomies were performed. Two ureteral catheters were passed retrograde into the renal pelves under fluoroscopic guidance. The lateral margins of the bladder, bladder neck, and urethra were surgically separated from the abdominal wall, and the bladder was closed, forming a hollow viscus. The symphysis pubis was closed on midline with horizontal mattress sutures. The defects in the vestibule and clitoral fossa were closed. Lastly, the iliac osteotomies were stabilized. The dog was initially incontinent with right hind limb sciatic neuropraxia and developed pyelonephritis. Over time, the dog became continent with full return to orthopedic and neurologic function, but had recurrent urinary tract infections, developed renal azotemia likely associated with chronic pyelonephritis, and ultimately was euthanized 3.5 years after surgery because of end-stage kidney disease. CLINICAL RELEVANCE Bladder exstrophy and epispadias is a treatable but rare congenital abnormality. The procedure described could be considered for treatment of this condition, but care should be taken to monitor for urinary tract infections and ascending pyelonephritis.
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Favorito LA, Sobrinho U, Martins RG, Bastos JB. Vaginal prolapse in bladder exstrophy with complete duplication of the uterus. Int Urogynecol J 2016; 28:497-499. [PMID: 27647470 DOI: 10.1007/s00192-016-3155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Luciano Alves Favorito
- Section of Urology, Lagoa Federal Hospital, Rio de Janeiro, Brazil.
- Urogenital Research Unit, State University from Rio de Janeiro, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil.
| | - Ulisses Sobrinho
- Section of Urology, Lagoa Federal Hospital, Rio de Janeiro, Brazil
| | | | - Juliana Bezerra Bastos
- Section of Urology, Lagoa Federal Hospital, Rio de Janeiro, Brazil
- Urogenital Research Unit, State University from Rio de Janeiro, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil
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Mishra P, Rajendran S, Asimakidou M, Mushtaq I. Kelly procedure for male primary epispadias. J Pediatr Urol 2016; 12:212.e1-2. [PMID: 27593920 DOI: 10.1016/j.jpurol.2016.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Primary epispadias is a rare congenital malformation involving the urogenital system. In patients with epispadias, bladder closure enhances bladder growth and continence. METHODS Several steps were carried out to bring the bladder neck to the midline and allow tension-free bladder neck reconstruction and recreation of the natural angulation of urethra. The urethral plate and penile shaft were dissected and the corpora cavernosa separated, and then the bladder neck repair was performed. The urethral plate was tubularised and brought ventrally. The separated corpora were reapposed, avoiding torsion. The skin was reoriented to provide cover to the penis. RESULTS The Kelly procedure improves cosmesis and continence by reconstructing a tension-free bladder neck repair and lengthening the penis. CONCLUSION The video demonstrates the Kelly procedure for primary epispadias in a male child.
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Affiliation(s)
- Pankaj Mishra
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Simon Rajendran
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Maria Asimakidou
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Imran Mushtaq
- Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Valerio E, Vanzo V, Zaramella P, Salvadori S, Castagnetti M, Baraldi E. Exstrophy-Epispadias Complex in a Newborn: Case Report and Review of the Literature. AJP Rep 2015; 5:e183-7. [PMID: 26495181 PMCID: PMC4603851 DOI: 10.1055/s-0035-1556759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022] Open
Abstract
Aim The aim of this report is to present a brief review of the current literature on the management of EEC. Case Report A term male neonate presented at birth with classic bladder exstrophy, a variant of the exstrophy-epispadias complex (EEC). The defect was covered with sterile silicon gauzes and waterproof dressing; at 72 hours of life, primary closure without osteotomy of bladder, pelvis, and abdominal wall was successfully performed. Discussion EEC incidence is approximately 2.15 per 1,00,000 live births; several urological, musculocutaneous, spinal, orthopedic, gastrointestinal, and gynecological anomalies may be associated to EEC. Initial medical management includes use of occlusive dressings to prevent air contact and dehydration of the open bladder template. Umbilical catheters should not be positioned. Surgical repair stages include initial closure of the bladder and abdominal wall with or without osteotomy, followed by epispadias repair at 6 to 12 months, and bladder neck repair around 5 years of life. Those who fail to attain continence eventually undergo bladder augmentation and placement of a catheterizable conduit. Conclusion Modern-staged repair of EEC guarantees socially acceptable urinary continence in up to 80% of cases; sexual function can be an issue in the long term, but overall quality of life can be good.
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Affiliation(s)
- Enrico Valerio
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Valentina Vanzo
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Patrizia Zaramella
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Sabrina Salvadori
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Marco Castagnetti
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
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