A Realistic Look at Exstrophy of the Bladder

Abstract

SUMMARY Twenty‐eight cases of exstrophy of the bladder over a 32‐year period were divided into groups, 7 cases from 1936 to 1951 and 21 cases subsequent to 1951. Analysis revealed that ureterosigmoidostomy using the technique described is a very satisfactory procedure. Primary closure is facilitated by iliac osteotomy but incontinence and reflux remain a problem. A pelvic sling was found superior to a plaster cast following osteotomy. Reconstruction of the genitalia is a necessary procedure regardless of the primary surgery. A pull‐through epispadias repair in the male is described which preserves fertility and sexual function. The ileal conduit was utilised as a back‐up procedure.

Extrophy of the urinary bladder

“…A policy of selection is more sensible. Ezell & Carlson (1970) concluded that primary closure is indicated only for females with a large elastic bladder while Megalli & Lattimer (1973) decided to restrict it to patients whose parents refuse urinary diversion. Williams (1971) stated that the' extrophied bladder must be capable of inversion and of forming a cavity of at least 30 ml capacity.…”

Exstrophy of the Bladder: Treatment by Trigonosigmoidostomy—Long‐term Results

“…Fisher and Retik (1969) reviewed 26 cases of which 9 were continent. Ezell and Carlsson (1970) had 19 patients of whom 9 were reconstructed and 2 achieved good continence. Cendron (1971) obtained acceptable continence in 6 of 12 children; reflux was present in 3 of these cases.…”

“…Various methods have been used to treat the child with bladder exstrophy, including primary functional closure of the bladder (Fisher and Retik, 1969; Ezell and Carlsson, 1970; Marshall and Muecke, 1970; Cendron, 1971; Jeffs et al, 1972; Megalli and Lattimer, 1973; Williams and Keeton, 1973), ureteroilealcolostomy (Houtappel, 1963), primary ureterosigmoidostomy (Spence, 1966; King and Wendel, 1972; Bennett, 1973; Megalli and Lattimer, 1973), rectal bladder with adjacent colon pull through (Mauclaire, 1895; Heitz-Boyer and Hovelaque, 1912;Lowsley and Johnson, 1955;Duhamel, 1971;Nedelec et al, 1975), vesicoileosigmoidostomy (Hays et al, 1969;Singer and Pompino, 1966), bladder enlargement by intestinoplasty (Cukier and Ott, 1971;Martinez-Pineiro, 1976) and non-refluxing colon conduits (Hendren, 1976). An alternative approach in patients with bladder exstrophy consists of implanting the isolated trigone in the sigmoid colon.…”

Selective Surface Smoothening of Polymer Microlenses by Depth Confined Softening

“…Refractive microlens arrays (MLAs) are crucial in enabling applications such as collimators, optical interconnects, microfluidic sensors or diffusers . Lately, MLAs are finding applications in high volume market such as hand‐held consumer electronics, LED back lighting, light extraction in displays and in automotive industry for head‐up displays . The key driving forces for embracing micro‐optical devices are miniaturization and cost effectiveness.…”