The search for continence in bladder exstrophy: Bladder neck transection and Macedo catheterizable reservoir to augment the nativebladder |
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| Affiliation: | 1. Department of Urology, CACAU-NUPEP, São Paulo, Brazil;2. Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil;1. Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France;2. Centre de Référence des Maladies Rares Du Calcium et Du Phosphore, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France;3. Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, France;4. Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France;5. Laboratoire de Biochimie, Centre Hospitalier Lyon Sud, Pierre Bénite, France;6. ISPB Faculté de Pharmacie de Lyon, Université Lyon 1, Lyon, France;7. Service de Génétique, CHU de Caen, Caen, France;8. Centre de Référence des Maladies Rares Du Calcium et Du Phosphate, Caen, France;9. INSERM 1033 Research Unit, Lyon, France;1. Department of Urology, University of Virginia, 1300 Jefferson Park Ave, Charlottesville, VA, USA;2. Department of Urology, Boston Children''s Hospital, 75 Francis St, Boston, MA, USA;3. Division of Urology, Virginia Commonwealth University, 1000 E Broad St, Richmond, VA, USA;4. Department of Radiology, Boston Children''s Hospital, 300 Longwood Avenue Boston, MA, USA;1. Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Colombia;2. Department of Urology, Fundacion Santa Fe de Bogota, Universidad de Los Andes, Colombia;1. Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France;2. Unité de Soutien Méthodologique, Hôpital Bellepierre, CHU de La Réunion, France;3. Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France;4. Société Francophone d''Urologie Pédiatrique et de l''Adolescent (SFUPA), France |
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| Abstract: | IntroductionBladder exstrophy remains one of the most challenging abnormalities in pediatric urology. We propose bladder neck transection and bladder augmentation with a catheterizeable reservoir technique to achieve continence after previous anatomic reconstruction in stages.MethodsAt the age of 5–6 years, we offer the transection of bladder neck and enterocystoplasty to achieve continence. We report on a 6-year-old boy that underwent this procedure. We perform the reservoir from ileum according to Macedo-technique that constructs a catheterizeable channel from the same bowel segment. The continence mechanism of the efferent tube is based on angulation and a serous lined tunnel created with 3.0 prolene sutures. The stoma is placed in the midline.ResultsPatient had an uneventful evolution and is continent performing CIC every 4 h with 9 months of follow up.DiscussionIn spite of continuous development of bladder exstrophy surgery, the urethral continence and voluntary micturition is still not possible in the majority of patients. We discuss with our patients honestly and offer this method as a viable alternative to achieve continence.ConclusionIn our experience, most patients accept urethral transection and suprapubic CIC when educated about results with other alternatives of bladder neck plasty. |
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| Keywords: | Bladder exstrophy Continence Bladder neck closure |
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