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Complete Penile Disassembly (CPD) for Epispadias Repair in Postpubertal Patients
S52 a satisfactory size (>30 mm) of bladder plate, and group 2 included 18 (30%) with a small size (< 30 mm). Irrespective of the size of bladder template, all children underwent primary closure, bladder neck reconstruction, and pubic bone approximation.
RESULTS The outcomes of primary closure were analyzed with regard to detrusor volume and dry periods. In the children under one year
ESPU Programme 2009 of age, the volume of the bladder was 3070 ml in group 1 and 20-40 mm in group 2. However, 12 children from group 2 voided small portions of urine with dry periods of up to 10-15 min. At the age 1-3 years old, the children from group 2, with small bladder plates, underwent Cantwell-Ransley repair combined with grafting dorsal surface of corporeal bodies with endoscopic VUR correction (STING) as the second step of treatment. Finally, the bladder volume in the children from group 2 increased up to 5060 ml, with dry periods of up to 30-40 min. At
the next step of treatment, six patients from group 2 underwent uretrocystoneoctomy and bladder neck plasty. As a result, in the children of 1-3 years old, with small bladder plates, the bladder volume was 70-120 ml and dry periods were 40-70 min.
CONCLUSIONS Our findings evidence that, even with small bladder plates, it is possible to achieve satisfactory outcomes of treatment of bladder exstrophy
# S06-6 (O) THE UTILITY OF REPEAT PELVIC OSTEOTOMY IN FACILITATING CLOSURE OF THE EXSTROPHY PATIENT Brian TULLY1, Thomas NOVAK2, Erin MACK3, Paul SPONSELLER4 and John GEARHART2 1 University of Maryland Medical Center, Urology, Catonsville, USA, 2The James Buchanan Brady Urological Institute, Urology, Baltimore, USA, 3The Johns Hopkins University School of Medicine, Baltimore, USA, 4The Johns Hopkins Hospital, Orthopedic Surgery, Baltimore, USA
INTRODUCTION Failed primary closure of the exstrophic bladder is a serious complication with significant impact on the continence outcomes and stability of the urinary tract. Pelvic ostetomy is a critical component of repeat closure as it facilitates a tensionfree approximation of the pubis and abdominal wall, and gives the best chance for a successful outcome. This study examines the success rates and complications of repeat pelvic osteotomy(RPO) following failed closure of patients with classic bladder and cloacal exstrophy.
METHODS The authors analyzed patient data from our institutionally-approved exstrophy database
and identified all bladder and cloacal exstrophy patients who have undergone RPO in conjuction with repeat exstrophy closure. Within this select group we analyzed patient history, complications, and orthopedic outcomes.
RESULTS 75 patients who underwent RPO were identified from the database, 56% male and 44% female. In 83% of patients, RPO was performed prior to 36 months of age. Mean time from initial to repeat osteotomy was 20 months. Anterior inominate osteotomy was utilized in 41% of cases, while combined transverse-anterior inominate/ vertical iliac comprised 40% of cases. All cloacal exstrophy patients remain closed, while 5(7%) of the bladder exstrophy patients required repeat bladder closure.
Minor complications, such as pin site infections or loose hardware, were observed in 10 patients. 3 patients had major infections of the hardware, and 3 patients had non-union of their pelvic bones after osteotomy. 63 patients now walk with a normal gait, 10 ambulate with assistance or with a limp, while only 2 are non-ambulatory.
CONCLUSIONS A failed exstrophy closure is a serious complication which significantly affects the functional outcome of the child. When performed in conjunction with repeat pelvic osteotomy and proper immobilization, secondary closure can be successful and safely performed, and major postosteotomy complications are uncommon.
# S06-7 (PP) COMPLETE PENILE DISASSEMBLY (CPD) FOR EPISPADIAS REPAIR IN POSTPUBERTAL PATIENTS Ashraf HAFEZ Riyadh Armed Forces Hospital, Department of Urology, Riyadh, SAUDI ARABIA
PURPOSE CPD is widely utilized for epispadias repair. Herein, the outcome of such technique in 14 post pubertal patients is presented.
MATERIAL AND METHODS Between July 2001 and May 2008, a total of 14 post pubertal patients underwent CPD
epispadias repair. Mean age at surgery was 18.9 years (range 14-34). Eleven patients were born with bladder exstrophy. Six patients had previous cystectomy and rectal diversion with no epispadias repair. The remaining 5/11 exstrophy patients had bladder neck closure, ileocystoplasty and continent outlet. The remaining 3/14 patients had isolated penopubic epispadias and all underwent previous failed epispadias repairs. Urethral stent was used for patients
with isolated epispadias. The first postoperative follow-up was at 6 weeks. Later patients were followed every 3 months for one year.
RESULTS All patients had an orthotopic meatus intraoperatively. However, the short urethral plate was augmented with a penile skin flap
ESPU Programme 2009 in 5/14(36%) patients. No patient had glans/ corporal ischemia. All patients had normal conical symmetrical glans/corpora. One, redo, patient had sloughing of the distal neourethra and ended up with a coronal hypospadias. All the remaining 13/14 (93%) patients had orthotopic meatus with no fistula, stenosis, or dehiscence. All neourethras were easily calibrated with 14F
S53 sound. All patients had normal straight erections with normal forward ejaculation.
a penile skin flap is required in one third of patients. With careful dissection, the erection/ejaculatory functions are preserved in all patients.
CONCLUSIONS CPD is safe and effective for epispadias repair in post pubertal patients. Augmentation of the urethral plate with
# S06-8 (PP) MANAGEMENT OF BLADDER EXSTROPHY IN ADULTHOOD: REPORT OF 5 CASES Ahmed SHOUKRY and Ismail SHOUKRY Cairo University, Urology, Giza, EGYPT
PURPOSE To report our experience in management of adult classic bladder exstrophy. Adult classic bladder exstrophy is a rare condition, and there is a paucity in the literature in such reports.
MATERIAL AND METHODS During the period between 1977 and 2004 we treated five adult males presenting with classic exstrophy epispadias complex. The patients’ age of presentation ranged from 12 to 30 with a median age 20. Four of them had no previous treatment and one patient underwent previous ureterosigmoidostomy urinary diversion but with bladder patch not operated on. Workup of these patients
included evaluation of upper tract, bladder biopsy. The bladder patch condition was good on surgery and accommodated the hand’s fist. Surgery involved bladder preservation in three patients. In addition to bladder closure and epispadias repair (1 patient), two patients also had augmentation ileocystoplasty. The remaining 2 patients underwent ureterosigmoidostomy and later on cystectomy and epispadias repair due to very small bladder patch. Osteotomy was not done in any case.
RESULTS In patients with bladder preservation, one patient was continent (more then 3 hours) and voids spontaneously whereas the other
two showed day and night continence (2-3 hours) with mild stress incontinence. Patients were satisfied with functional outcome. Ultrasound and intravenous pylography showed preservation of upper tract. Follow up period ranged from 1 year to 8 years.
CONCLUSIONS Patients with bladder exstrophy presenting in adult should not be denied the opportunity of primary reconstruction with bladder preservation in absence of significant histologic changes in the bladder mucosa. Osteotomy was not done in any case.
# S06-9 (PP) LIVING WITH BLADDEREXSTROPHY e THE PATIENTS‘ PERSPECTIVE Brigitte SELINER1, Rita GOBET2, Petra METHENTHIN3 and Rebecca SPIRIG4 1 University Childrens hospital of Zurich, Rehabilitation, Zurich, SWITZERLAND, 2University Children’s Hospital Zurich, Urology, Zurich, SWITZERLAND, 3Berner Fachhochschule, Clinical Nursing Science, Bern, SWITZERLAND, 4University Hospital Basel, Clinical Nursing Science, Basel, SWITZERLAND
PURPOSE
MATERIAL AND METHODS
Bladderexstrophy (BE) is a rare but severe urogenital malformation that requires complex clinical management. It can lead to physical restriction as well as to psychosocial and psychosexual malfunction. Unfortunately, little is known about the experiences of persons living with BE from childhood into adulthood. The aim of this study was to explore the experiences of persons with BE, their perception of life and the way they cope with their illness.
In this retrospective qualitative study semistructured interviews were conducted with four women and sixteen men (38 to 68 years). The data were analyzed by content analysis techniques.
RESULTS two major categories with two to five subcategories emerged from the data.The first major category ‘‘Living with BE’’ was
categorized by episodes and experiences that were repeated throughout the persons life, such as ‘‘being in the hospital,’’, ‘‘living with symptoms’’, ‘‘being different’’, ‘‘showing oneself’’, and ‘‘gathering information.’’. The two subcategories ‘‘parents’’ and ‘‘partners’’ demonstrate that they are affected too and provide considerable support to the person with BE. The second major category ‘‘Nonetheless, having a good life’’, describes the perception of the affected persons to lead a life worth living despite the BE.
RESULTS The outcomes of primary closure were analyzed with regard to detrusor volume and dry periods. In the children under one year
ESPU Programme 2009 of age, the volume of the bladder was 3070 ml in group 1 and 20-40 mm in group 2. However, 12 children from group 2 voided small portions of urine with dry periods of up to 10-15 min. At the age 1-3 years old, the children from group 2, with small bladder plates, underwent Cantwell-Ransley repair combined with grafting dorsal surface of corporeal bodies with endoscopic VUR correction (STING) as the second step of treatment. Finally, the bladder volume in the children from group 2 increased up to 5060 ml, with dry periods of up to 30-40 min. At
the next step of treatment, six patients from group 2 underwent uretrocystoneoctomy and bladder neck plasty. As a result, in the children of 1-3 years old, with small bladder plates, the bladder volume was 70-120 ml and dry periods were 40-70 min.
CONCLUSIONS Our findings evidence that, even with small bladder plates, it is possible to achieve satisfactory outcomes of treatment of bladder exstrophy
# S06-6 (O) THE UTILITY OF REPEAT PELVIC OSTEOTOMY IN FACILITATING CLOSURE OF THE EXSTROPHY PATIENT Brian TULLY1, Thomas NOVAK2, Erin MACK3, Paul SPONSELLER4 and John GEARHART2 1 University of Maryland Medical Center, Urology, Catonsville, USA, 2The James Buchanan Brady Urological Institute, Urology, Baltimore, USA, 3The Johns Hopkins University School of Medicine, Baltimore, USA, 4The Johns Hopkins Hospital, Orthopedic Surgery, Baltimore, USA
INTRODUCTION Failed primary closure of the exstrophic bladder is a serious complication with significant impact on the continence outcomes and stability of the urinary tract. Pelvic ostetomy is a critical component of repeat closure as it facilitates a tensionfree approximation of the pubis and abdominal wall, and gives the best chance for a successful outcome. This study examines the success rates and complications of repeat pelvic osteotomy(RPO) following failed closure of patients with classic bladder and cloacal exstrophy.
METHODS The authors analyzed patient data from our institutionally-approved exstrophy database
and identified all bladder and cloacal exstrophy patients who have undergone RPO in conjuction with repeat exstrophy closure. Within this select group we analyzed patient history, complications, and orthopedic outcomes.
RESULTS 75 patients who underwent RPO were identified from the database, 56% male and 44% female. In 83% of patients, RPO was performed prior to 36 months of age. Mean time from initial to repeat osteotomy was 20 months. Anterior inominate osteotomy was utilized in 41% of cases, while combined transverse-anterior inominate/ vertical iliac comprised 40% of cases. All cloacal exstrophy patients remain closed, while 5(7%) of the bladder exstrophy patients required repeat bladder closure.
Minor complications, such as pin site infections or loose hardware, were observed in 10 patients. 3 patients had major infections of the hardware, and 3 patients had non-union of their pelvic bones after osteotomy. 63 patients now walk with a normal gait, 10 ambulate with assistance or with a limp, while only 2 are non-ambulatory.
CONCLUSIONS A failed exstrophy closure is a serious complication which significantly affects the functional outcome of the child. When performed in conjunction with repeat pelvic osteotomy and proper immobilization, secondary closure can be successful and safely performed, and major postosteotomy complications are uncommon.
# S06-7 (PP) COMPLETE PENILE DISASSEMBLY (CPD) FOR EPISPADIAS REPAIR IN POSTPUBERTAL PATIENTS Ashraf HAFEZ Riyadh Armed Forces Hospital, Department of Urology, Riyadh, SAUDI ARABIA
PURPOSE CPD is widely utilized for epispadias repair. Herein, the outcome of such technique in 14 post pubertal patients is presented.
MATERIAL AND METHODS Between July 2001 and May 2008, a total of 14 post pubertal patients underwent CPD
epispadias repair. Mean age at surgery was 18.9 years (range 14-34). Eleven patients were born with bladder exstrophy. Six patients had previous cystectomy and rectal diversion with no epispadias repair. The remaining 5/11 exstrophy patients had bladder neck closure, ileocystoplasty and continent outlet. The remaining 3/14 patients had isolated penopubic epispadias and all underwent previous failed epispadias repairs. Urethral stent was used for patients
with isolated epispadias. The first postoperative follow-up was at 6 weeks. Later patients were followed every 3 months for one year.
RESULTS All patients had an orthotopic meatus intraoperatively. However, the short urethral plate was augmented with a penile skin flap
ESPU Programme 2009 in 5/14(36%) patients. No patient had glans/ corporal ischemia. All patients had normal conical symmetrical glans/corpora. One, redo, patient had sloughing of the distal neourethra and ended up with a coronal hypospadias. All the remaining 13/14 (93%) patients had orthotopic meatus with no fistula, stenosis, or dehiscence. All neourethras were easily calibrated with 14F
S53 sound. All patients had normal straight erections with normal forward ejaculation.
a penile skin flap is required in one third of patients. With careful dissection, the erection/ejaculatory functions are preserved in all patients.
CONCLUSIONS CPD is safe and effective for epispadias repair in post pubertal patients. Augmentation of the urethral plate with
# S06-8 (PP) MANAGEMENT OF BLADDER EXSTROPHY IN ADULTHOOD: REPORT OF 5 CASES Ahmed SHOUKRY and Ismail SHOUKRY Cairo University, Urology, Giza, EGYPT
PURPOSE To report our experience in management of adult classic bladder exstrophy. Adult classic bladder exstrophy is a rare condition, and there is a paucity in the literature in such reports.
MATERIAL AND METHODS During the period between 1977 and 2004 we treated five adult males presenting with classic exstrophy epispadias complex. The patients’ age of presentation ranged from 12 to 30 with a median age 20. Four of them had no previous treatment and one patient underwent previous ureterosigmoidostomy urinary diversion but with bladder patch not operated on. Workup of these patients
included evaluation of upper tract, bladder biopsy. The bladder patch condition was good on surgery and accommodated the hand’s fist. Surgery involved bladder preservation in three patients. In addition to bladder closure and epispadias repair (1 patient), two patients also had augmentation ileocystoplasty. The remaining 2 patients underwent ureterosigmoidostomy and later on cystectomy and epispadias repair due to very small bladder patch. Osteotomy was not done in any case.
RESULTS In patients with bladder preservation, one patient was continent (more then 3 hours) and voids spontaneously whereas the other
two showed day and night continence (2-3 hours) with mild stress incontinence. Patients were satisfied with functional outcome. Ultrasound and intravenous pylography showed preservation of upper tract. Follow up period ranged from 1 year to 8 years.
CONCLUSIONS Patients with bladder exstrophy presenting in adult should not be denied the opportunity of primary reconstruction with bladder preservation in absence of significant histologic changes in the bladder mucosa. Osteotomy was not done in any case.
# S06-9 (PP) LIVING WITH BLADDEREXSTROPHY e THE PATIENTS‘ PERSPECTIVE Brigitte SELINER1, Rita GOBET2, Petra METHENTHIN3 and Rebecca SPIRIG4 1 University Childrens hospital of Zurich, Rehabilitation, Zurich, SWITZERLAND, 2University Children’s Hospital Zurich, Urology, Zurich, SWITZERLAND, 3Berner Fachhochschule, Clinical Nursing Science, Bern, SWITZERLAND, 4University Hospital Basel, Clinical Nursing Science, Basel, SWITZERLAND
PURPOSE
MATERIAL AND METHODS
Bladderexstrophy (BE) is a rare but severe urogenital malformation that requires complex clinical management. It can lead to physical restriction as well as to psychosocial and psychosexual malfunction. Unfortunately, little is known about the experiences of persons living with BE from childhood into adulthood. The aim of this study was to explore the experiences of persons with BE, their perception of life and the way they cope with their illness.
In this retrospective qualitative study semistructured interviews were conducted with four women and sixteen men (38 to 68 years). The data were analyzed by content analysis techniques.
RESULTS two major categories with two to five subcategories emerged from the data.The first major category ‘‘Living with BE’’ was
categorized by episodes and experiences that were repeated throughout the persons life, such as ‘‘being in the hospital,’’, ‘‘living with symptoms’’, ‘‘being different’’, ‘‘showing oneself’’, and ‘‘gathering information.’’. The two subcategories ‘‘parents’’ and ‘‘partners’’ demonstrate that they are affected too and provide considerable support to the person with BE. The second major category ‘‘Nonetheless, having a good life’’, describes the perception of the affected persons to lead a life worth living despite the BE.