Classic bladder exstrophy-salvage reconstructive procedures

OBJECTIVE: In some exstrophy patients, despite multiple operations, there remains urethral fistulas, incontinence, small penis with dorsal chordee and considerable cosmetic defect which include ugly scars on the lower abdomen and the absence of umbilicus. We present our experience with one stage salvage reconstructive procedures in the patients. METHODS. In the past 18 month 9 children (7 males, 2 females) undervent salvage reconstructive procedures in one stage. The mean age was 12 (range 5-19) years. All patients were treated at our institute since birth. In all of the boys there were 2-4 urethral fistulas. The surgery included rhomboid flaps abdominoplasty, umbilicoplasty, repair of urethral fistula, chordee repair, penile legthening, glanduloplasty, bladder neck reconstruction, bladder augmentation and cystolithotomy according to the individual needs RESULTS: In all children significant cosmetic improvement of the abdomen and external genitalia was achieved according to patient family and physician The patient who underwent bladder neck reconstruction is pressently voiding spontaneously and remains dry for an hour while the girl who underwent bladder neck reconstruction and bladder augmentation is dry on CIC Only 2 urethral fistula reappeared after the surgery. Two patients had mild wound dehiscence at the abdominal flaps and one child had UTI. CONCLUSION: Salvage reconstructive procedures of bladder exstrophv can be safely performed in one stage with good results.