Mobilization of pelvic musculature and its effect on continence in classical bladder exstrophy: A single-center experience of 38 exstrophy repairs

Pathogenesis of bladder exstrophy: A new hypothesis

“…Our hypothesis is also the basis for our technique of surgical repair [3], done in two stages avoiding osteotomy. The bladder is closed in the neonatal period (Stage 1).…”

“…Cheng et al [26] suggested p63 as a candidate gene involved in human bladder exstrophy, and that dysregulation of p63 expression could be Surgical correction in bladder exstrophy will be more effective if the exact pathogenetic mechanism has been deduced, as the surgical procedure could be directed to correct the cause of the defect. Correction of pubic diastasis tends to be disrupted over time, hence correction of the levator from a hammock to a U-loop could be more appropriate, as has been previously reported [3].…”

“…The functional outcome of 38 children with bladder exstrophy managed over a period of 10 years was reviewed [3]. At a mean follow-up of 4.5 years (range 2.5-8 years), 24 of the 38 children (63.5%) had attained grade 1 continence (volitional voiding with dry intervals of more than 3 hours in day time with no stress incontinence and dry at night).…”

“…A simplified way of describing this anomaly is to imagine passing a pair of scissors through the urethra into are also not uniform among the studies, which use different techniques for repair. We recently published our technique for bladder exstrophy repair with reasonable outcome [3]. We firmly believe that clear knowledge of the etio-pathogenesis of the developmental defect in bladder exstrophy-epispadias complex could be significant to guide proper and effective surgical repair.…”

The radical soft-tissue mobilization (Kelly repair) for bladder exstrophy

“…Radical soft-tissue mobilization is based on the assumption that some functional muscular structures with potential for sphincteric function do exist in bladder exstrophy patients [2][3]. Their detachment from the bony pelvis enables a tensionfree reconstruction, and may favor development of physiological continence mechanisms, independently of inevitable pubic symphisis re-enlargement.…”