Exstrophy Bladder – Reconstruction or Diversion for the Underprivileged
- 114 Downloads
The surgical techniques for management of bladder exstrophy epispadias complex have evolved from staged reconstruction, complete primary repair to radical mobilization. Post-operative complications add to the multiplicity of surgical procedures at each step. The end results are variable with many achieving continence rates of 85–89% only after bladder augmentation and clean intermittent catheterization. The situation is further complicated in resource-poor settings, where illiteracy and poverty are the driving factors for choosing a single operative procedure for creation of low pressure reservoir aiming at upper tract preservation and good primary continence. Thus, primary urinary diversion should be offered as a surgical option to patients with limited access to health care facilities. Yogesh’s cystorectostomy is a modification of Heitz-Boyer-Hovelacque procedure, wherein the bladder plate is directly anastomosed to the recto-sigmoid pouch, without mobilizing the ureters from their original location. The short-term follow-ups are encouraging with all achieving total urinary continence over the ensuing months. The upper tract functions are well preserved, along with huge parental and patient satisfaction and overall improvement in the quality of life.
KeywordsBladder exstrophy Developing countries Epispadias Health services accessibility Urinary incontinence
VS did review of literature, prepared the initial draft and YKS conceptualized the article, described the surgical steps and the initial experience with a novel procedure and sorted the final draft. YKS shall stand as guarantor for the article.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 2.Gearhart JP. The bladder exstrophy-epispadias-cloacal exstrophy complex. In: Gearhart JP, Rink RC, Mouriquand PDE, editors. Pediatric Urology, Chapter 32, vol. 2. Philadelphia: WB Saunders Co.; 2001. p. 511–46.Google Scholar
- 4.Epidemiology of bladder exstrophy and epispadias: a communication from the International Clearing House for Birth Defects Monitoring Systems. Teratology. 1987;36:221–7.Google Scholar
- 9.Coffey RC. Production of aseptic ureteroenterostomy: by a suture transfixing the ureteral wall and the intestinal mucosa. JAMA. 1930;94:1748–50.Google Scholar
- 12.Ray AK, Mukherjee NN, Mukherjee S, Mukherjee P. Total correction of bladder exstrophy – our experience in 37 patients. Indian J Urol. 2002;18:117–9.Google Scholar
- 14.Mouriquand PD. Bubanj T, Feyaerts, et al. Long-term results of bladder neck reconstruction for incontinence in children with classical bladder exstrophy or incontinent epispadias. BJU Int. 2003;92:997–1001.Google Scholar
- 16.Mollard P, Mouriquand PD, Buttin X. Urinary continence after reconstruction of classical bladder exstrophy (73 cases). Br J Urol. 1994;73:298–302.Google Scholar
- 34.Woodhouse CR; British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidelines for monitoring of patients with ureterosigmoidostomy. Gut. 2002;51:V15–6.Google Scholar