Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap

Abstract

Background:The aim of this study was to investigate the efficacy of the rectus abdominis myo-peritoneal flap (RAMP) technique for the closure and augmentation of small, non-elastic, non-compliant bladder exstrophies.Materials and Methods:The RAMP technique was used in three boys with bladder exstrophy who presented late with small, non-elastic, non-compliant bladder. The clinical outcome, imaging, cystoscopy, biochemical and microbiological studies were assessed during a follow-up of 36 months.Results:Bladder closure and augmentation was achieved in all patients without any complications. There were no urinary tract infections, metabolic problems or electrolyte disturbances and the kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMP with uroepithelium. No stone formation or mucous production was detected.Conclusions:The RAMP technique is a good alternative for closing bladder exstrophies and achieves an increase in bladder capacity and compliance. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures.

Evidence-based demerits on the use of rectus abdominis musculo-peritoneal flap for bladder augmentation in children with exstrophy bladder

“…We read the article “Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap (RAMP).”[1] The authors reported the results of RAMP for primary bladder augmentation (BA) in children presenting late with bladder exstrophy (BE) with poor bladder template. [1] The technique claimed to decrease the morbidity and postoperative complications.…”

“…[1] The technique claimed to decrease the morbidity and postoperative complications. [1] We would differ with these observations.…”

“…[1] The technique claimed to decrease the morbidity and postoperative complications. [1] We would differ with these observations. The ideal management of BE aims not just to achieve an anatomical closure of the defect, as illustrated in the present study,[1] but also to achieve a compliant urinary reservoir of adequate capacity with preserved upper urinary tract along with continence and cosmetically pleasing external genitalia.…”

“…The ideal management of BE aims not just to achieve an anatomical closure of the defect, as illustrated in the present study,[1] but also to achieve a compliant urinary reservoir of adequate capacity with preserved upper urinary tract along with continence and cosmetically pleasing external genitalia. [2] The major limitation of this report[1] is the nonassessment of the functional status of the reconstructed bladder by uroflowmetry and filling cystometry. Moreover, the postoperative ultrasonography (USG) mentioned just about bladder capacity and failed to mention the status of kidneys, ureters, and postvoid residual urine.…”

“…Moreover, the postoperative ultrasonography (USG) mentioned just about bladder capacity and failed to mention the status of kidneys, ureters, and postvoid residual urine. [1] Though USG and intravenous pyelography are useful tools to assess upper tract dilatation, yet they lack functional information. In the absence of the renal radionuclide scans, the assessment of upper urinary tracts in this study[1] is incomplete.…”