One-stage combined delayed bladder closure with Kelly radical soft-tissue mobilization in bladder exstrophy: preliminary results

Leclair, Marc‐David; Faraj, S.; Sultan, Sajid; Audry, G; Héloury, Yves; Kelly, Justin H.; Ransley, Philip G.

doi:10.1016/j.jpurol.2018.07.013

Cited by 25 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Continence in FE is also influenced by primary surgery, which according to our experience is preferably performed by perineal approach 25 while the Kelly technique is useful in severe FE forms. 3…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence in Bladder Exstrophy-epispadias Complex

et al. 2023

View full text Add to dashboard Cite

Purpose: Since bladder neck dextranomer/hyaluronic acid copolymer (Deflux) injections can improve urinary incontinence of various etiologies, we hypothesized that incontinent children with bladder exstrophy-epispadias complex would benefit from dextranomer/hyaluronic acid copolymer. We aimed to analyze dextranomer/hyaluronic acid copolymer efficacy and predictors of treatment success in bladder exstrophy-epispadias complex. Materials and Methods: Incontinent bladder exstrophy-epispadias complex children aged >4 years undergoing dextranomer/hyaluronic acid copolymer injections in our hospital between October 1997 and January 2021 were included. Medical history, continence, and bladder capacity before injections were recorded. Postoperatively, patients were categorized as "dry," "significantly improved," or "failure." Postoperative complications, bladder emptying mode, and bladder capacity were reported. Failure-free survival was estimated by Kaplan-Meier models. Results: Altogether, 58 patients (27 male epispadias, 9 female epispadias, 22 bladder exstrophy) underwent 105 injections at median age of 8.5 (interquartile range 5.8-12) years. Previous bladder neck reconstruction had been performed in 38 (66%) and 33 (57%) received multiple injections. Complications occurred in 9%. Five-year failurefree survival was 70% (standard error 9.1) in males epispadias compared to 45% (9.0) in females and exstrophy patients (P [ .04). Previous bladder neck reconstruction associated with improved 5-year failure-free survival in females and exstrophy patients (58%, SE 11) but not in male epispadias (75%, SE 11). Conclusions: Dextranomer/hyaluronic acid copolymer injections provided satisfactory and lasting continence in over half of bladder exstrophy-epispadias complex patients. While injections were successful in male epispadias regardless of bladder neck reconstruction timing, results were better in bladder exstrophy and female epispadias after previous bladder neck reconstruction.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment of BEEC consists of bladder reconstruction, epispadias repair, and bladder neck reconstruction (BNR), which can be performed as modern staged repair, 1 complete primary repair, 2 or radical soft tissue mobilization. 3 Regardless of the primary closure technique, continence rates vary between 33% and 70%. 4-7…”

mentioning

confidence: 99%

Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence in Bladder Exstrophy-epispadias Complex

et al. 2023

View full text Add to dashboard Cite

show abstract

“…In comparison to the specimens of newborns with BE (5) active inflammation was more common but fibrosis and more severe inflammation was not more frequent in delayed closure. Ferrara et al suggested that some microscopic changes, such as squamous metaplasia, reverse to normal after bladder closure (6, 7). Literature on mucosal changes in early life in BE is rare.…”

Section: Timingmentioning

confidence: 99%

“…RSTM is an anatomical reconstruction of BE generally performed as part of a two-staged strategy following successful neonatal closure. Complete delayed bladder closure with RSTM is a recently published modification of this concept (6).…”

Section: Main Surgical Conceptsmentioning

confidence: 99%

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

Promm¹,

Roêsch²

2019

Front. Pediatr.

View full text Add to dashboard Cite

Although enormous effort has been made to further improve the operative techniques worldwide, the management of bladder exstrophy (BE) remains one of the most significant challenges in pediatric urology. Today it is universally agreed that successful and gentle initial bladder closure is decisive for favorable long-term outcome with regard to bladder capacity, renal function and continence. Due to a number of reasons, including a lack of comparable multicenter studies, a range of concepts is currently used to achieve successful primary closure. We review the literature of the last 15 years on the current concepts of bladder exstrophy repair with regard to the time of primary closure (initial vs. delayed closure), the concepts of primary closure (single-stage vs. staged approach; without osteotomy vs. osteotomy) and their outcomes. There is a worldwide lack of multicenter outcome studies with adequate patient numbers and precisely defined outcome parameters, based on the use of validated instruments. The modern staged repair (MRSE) in different variations, the complete primary reconstruction of exstrophy (CPRE), and the radical soft-tissue mobilization (RSTM) had been the most extensively studied and reported procedures. These major concepts are obligatory stable now for more than 20 years. Nevertheless, there are still a lot of open-ended questions e.g., on the potential for development of the bladder template, on continence, on long-term orthopedic outcome, on sexuality and fertility and on quality of life. Management of BE remains difficult and controversial. Further, clinical research should focus on multi-institutional collaborative trials to determine the optimal approach.

show abstract

“…4 Managing Epispadias is a great challenge, its management is mainly surgical involving bladder closure, urethral reconstruction and osteotomies if pubic diastasis is present, further surgery may be necessary to correct complications of initial surgeries or to achieve improved cosmesis or compete continence. 5…”

Section: Introductionmentioning

confidence: 99%

A case report on continent isolated male epispadias.

Ali

Hussain

Khalid

et al. 2020

TPMJ

View full text Add to dashboard Cite

Epispadias is a rare congenital anomaly in which the urethral opening is on the dorsal surface of penis. Its incidence is 1 in 117000 newborn males and 1 in 484000 in newborn females. Its etiology is considered as because of failure of medial migration of mesenchyme between the ectodermal and endodermal layers of cloacal membrane due to premature rupture of cloacal membrane. Epispadias often presents as exstrophy epispadias complex, a wide spectrum of abnormalities that consist of classic bladder exstrophy, Epispadias and cloacal exstrophy. This case was not a part of exstrophy epispadias complex and it was an isolated continent epispadias which is extremely rare and it was managed with Cantwell Ransley epispadias repair technique.

show abstract

One-stage combined delayed bladder closure with Kelly radical soft-tissue mobilization in bladder exstrophy: preliminary results

Cited by 25 publications

References 24 publications

Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence in Bladder Exstrophy-epispadias Complex

Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence in Bladder Exstrophy-epispadias Complex

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

A case report on continent isolated male epispadias.

Contact Info

Product

Resources

About