Factors responsible for successful primary closure in bladder exstrophy

• Published in: Pediatric surgery international Vol. 16; no. 3; pp. 194 - 198
• Main Authors: KASAT, L. S, BORWANKAR, S. S
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.03.2000; Berlin Springer Nature B.V
• Subjects: Biological and medical sciences; Bladder Exstrophy - surgery; Child; Child, Preschool; Female; Humans; Ilium - surgery; Infant, Newborn; Male; Malformations of the urinary system; Medical sciences; Nephrology. Urinary tract diseases; Osteotomy; Surgical Wound Dehiscence - epidemiology; Urinary Catheterization; Urinary tract. Prostate gland; Human; Urinary system disease; Prognosis; Treatment efficiency; Vesical exstrophy; Infant; Urinary tract disease; Congenital disease; Long term; Newborn; Malformation; Surgery; Bladder disease; Predictive factor; Child
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s003830050721

To assess the important factors for successful primary closure in staged reconstruction of bladder exstrophy, 25 patients (18 males, 7 females) underwent primary bladder closure during the years 1993-1997. Twenty-one were more than 72 h old; all of these underwent bilateral posterior iliac osteotomies followed by primary bladder closure during the same anesthetic. Bladder closure was done in a double layer. The ureteric catheters were removed after 2 weeks and the bladder catheter after 3.5-4 weeks. Only 1 patient had a bladder dehiscence on the 10th postoperative day due to infection; 3 had partial wound dehiscences but no bladder dehiscence. One had a partial bladder prolapse. The osteotomies needed no drainage, and no complications occurred. One patient needed a urinary diversion 3 years after surgery as the bladder capacity did not increase. Eleven important factors play a pivotal role for successful primary bladder closure: (1) Proper patient selection; (2) A staged approach; (3) Anterior approximation of the pubic bones with placement of the bladder and urethra in the true pelvis; (4) Posterior bilateral iliac osteotomies in all indicated cases; (5) Double-layered closure of the bladder; (6) Two weeks' proper ureteric catheter drainage; (7) Prevention of infection; (8) Prolonged and proper postoperative immobilization; (9) Prompt treatment of bladder prolapse; (10) Prevention of abdominal distension postoperatively; and (11) Ruling out bladder-outlet obstruction before removing the bladder catheter.