A New Concept Concerning Treatment of Exstrophy of the Bladder

Ureterosigmoidostomy in Bladder Exstrophy

“…Some reports of patients with ureterosig moidostomy or trigonointestinal implantation with a fol low-up of more than 10 years are encouraging in respect to continence and upper urinary tract deterioration [9-11, 13, 21-27]. The late results of ileal conduits in chil dren are not satisfying, showing a high complication rate [7,22,[28][29][30][31], a fact also true of the results of colon con duit diversion without reflux prevention [29,32], The number of late follow-ups in colonic conduits with reflux prevention techniques is insufficient for com parison with the results of ileal conduits [9,10,[32][33][34][35], Late results on the reanastomosis of colonic conduits with the large bowel (conversion) to provide separation of feces and urine are not yet available.…”

“…Previous to this, we had treated 10 patients as follows: in 5 children the exstrophic bladder was implanted in the sigmoid colon using Boyce's modification of Maydl's technique [7]; in 3 a colostomy was performed and a rectal bladder constructed using the Heitz-Boyer-Hovelacque technique [8]; and in 2 children, urinary diversion was performed by means of colonic conduit.…”

Treatment of Patients with Bladder Exstrophy or Incontinent Epispadias

“…In 6 of them prima ry bladder closure and/or bladder neck reconstruction had failed; 1 was still incontinent after additional sling plasty. The remaining two conversions to ureterosigmoidostomy were performed in 1 adult with ileal conduit and in 1 after failure of a Boyce-Vest procedure [16] (table 2).…”

Extrophy of the urinary bladder

“…(1852) first performed ureterosigmoid anastomosis for a patient with extrophy of the bladder, and since then this operation has often been utilized. Other techniques of diversion which also employ the anal sphincter for urinary control, but which aim to separate the faecal and urinary streams, have been described by Gersuny (1898), Boyce & Vest (1952) and Lowsley &Johnson (1955). Bricker Method.…”