A short history of bladder exstrophy.

The first description of bladder exstrophy was noted on Assyrian tablets nearly 4000 years ago. Since then various papers has been published with an increasing rate. According to the available historical data, almost all operative techniques had been described during the last two centuries. We believe, the pioneers put a lot of work in this field and passed on their theoretic knowledge and surgical experience to the current era. Our duty is keep this treasure and add the benefits of recent new technological developments for the future care of our bladder exstrophy patients.

[The history of ureterosigmoidostomy]. / Die Entwicklung der Harnableitung in nicht ausgeschaltete Darmsegmente.

Congenital anomalies like bladder exstrophy were the indication in 1821 to implant the ureters into the sigmoid colon for the first time. In 1894 the Maydl technique was used more frequently with a postoperative mortality rate of 31%. The most important impact for ureterosigmoidostomy came from Robert Coffey in 1911. Obstruction at the ureterocolic anastomosis, inflammatory complications together with severe acidosis, renal insufficiency, and high mortality rates however gave way in 1950 to the worldwide success of Bricker's ileal conduit although at the same time the technique of ureterosigmoidostomy was perfected by Leadbetter, Goodwin, and Hohenfellner. About 25 years later, when the high late complication rate of ileal conduits was obvious, the advantages of ureterosigmoidostomy were reconsidered and the technique was refined using valuable principles of pouch surgery. Today modified ureterosigmoidostomy has a strong place among the possibilities of urinary diversion.

[Development of treatment for extrophy-epispadias in Germany]. / Geschichte der Blasenekstrophiebehandlung in Deutschland.

While repair of exstrophy has a long tradition in Germany, a comprehensive review of the medical history of exstrophy-epispadias repair and its frequent inconsistencies and setbacks in Germany has not previously been published. Numerous resources were used to collect the information described in this review. Older textbooks from the library of German Society of Urology (DGU) in Düsseldorf and from the School of Medicine Library at the Friedrich-Alexander University in Erlangen were used to collect information on the important steps in the treatment of bladder exstrophy and epispadias from the first report of it onward. A Medline search was done to collect appropriate information from after 1969. Schenck von Grafenberg was the first to describe exstrophy of the bladder, in his report published in 1597, while the term 'exstrophy' was first used by Chaussier in 1780. Isolated epispadias remained unknown and untreated until it was described by Morgagni in 1761. The initial attempts to treat this anomaly were restricted to controlling the incontinence. In 1869 Karl Thiersch described the etiology and anatomy of epispadias and reported on a case of epispadias reconstruction with a long-term follow-up of 11 years. As long ago as in 1897, Mickulicz enlarged a small exstrophic bladder by adding an ilial segment to make it possible to close the bladder. After the first really successful reconstruction of bladder exstrophy in 1942 by Young in the USA, various multiple-stage and single-stage reconstruction approaches emerged in Germany. From the start, urinary diversion was seen as an alternative to reconstruction in the treatment of bladder exstrophy. The first ureterosigmoidostomy was done in an exstrophy patient by Simon in Heidelberg in 1852, after which Maydl described a new technique based on transtrigonal sigmoidostomy for urinary diversion in 1894. There are now three approaches in current use in Germany for the management of bladder exstrophy-epispadias: reconstruction in various staged approaches, complete reconstruction in a single session, and the primary rectal reservoir (Mainz pouch II).

Modified Young-Dees-Leadbetter bladder neck reconstruction: new concepts about old ideas.

INTRODUCTION: The modern Young-Dees-Leadbetter bladder neck reconstruction is a procedure that has evolved during the past 82 years. During this time, the modifications and contributions of several urologic surgeons have improved the procedure and ultimate patient outcomes. We review the evolution and describe in detail our version of the Young-Dees-Leadbetter bladder neck reconstruction procedure. TECHNICAL CONSIDERATIONS: Optimally, patients should have a minimal bladder capacity of 85 mL and be mature enough to participate in a postoperative voiding program. Adequate radical exposure of the lateral aspects of the bladder and bladder neck are important. Cephalotrigonal or cross-trigonal ureteral reimplantation is typically performed to mobilize the ureters in relation to the proposed bladder neck and correct reflux. A mucosal template 15 mm wide by 30 mm long is created that will serve as the reconstituted posterior urethra and bladder neck. Triangular lateral bladder mucosal wedges are marked and demucosalized. The neourethra is closed over an 8F Firlit tube. The demucosalized flaps are brought over the urethra sequentially in a "vest-over-pants" fashion with the final layer consisting of suspension sutures. Finally, ureteral stents and a suprapubic tube are used, but no urethral catheter is left in place. CONCLUSIONS: The modern Young-Dees-Leadbetter bladder neck reconstruction is the result of the contributions of various urologic surgeons during 82 years. When patients are appropriately selected, it is an effective method of lower urinary tract reconstruction in cases of congenital urinary incontinence.

Hugh Hampton Young: a pioneer in pediatric urology.

PURPOSE: Hugh Hampton Young (1870-1945) is regarded as a major force in urology during the first half of the 20th century. While he is acknowledged for many advances in open and transurethral prostatic surgery, his contributions to pediatric urology have been less well recognized. MATERIALS AND METHODS: The manuscripts and autobiography of Hugh Hampton Young were reviewed and major contributions to pediatric urology were identified. Patient records corresponding to these areas were then obtained from the Alan Mason Chesney Medical Archives and reviewed. RESULTS: Hugh Hampton Young was the first clinically to recognize and surgically treat posterior urethral valves, the first to develop a procedure to correct incontinence in patients with the epispadias-exstrophy complex and the first to describe bilateral subtotal adrenalectomy for virilization secondary to congenital adrenal hyperplasia. He was successful in his endeavors and his techniques are still in use today or have become the building blocks of future modifications. CONCLUSIONS: The contributions of Hugh Hampton Young to pediatric urology were numerous. In addition to his accomplishments in academic and adult urology, Young should be recognized as a true pioneer in pediatric urology.

Exstrophy of bladder: evolution of management.

Eighty-nine patients with bladder exstrophy were seen at our institution over the last fifty years. There were 63 males and 26 females. Cloacal exstrophy constituted 9 per cent of our experience. Twenty-seven patients underwent primary urinary diversion with subsequent genital reconstruction early on in our series. Of the 57 children operated on since 1951, 50 were judged eligible for and underwent a planned multistaged reconstruction. We realized a 50 per cent success rate. The majority of failures were diverted into an ileal conduit for persistent incontinence.

Exstrophy of the bladder progress of management during the last 25 years.

The different methods of treatment of bladder exstrophy are described. Ureterosigmoidostomy and its various modifications are discussed and the longterm result critically reviewed. Urinary diversion by transplanting the ureters into an isolated segment of ileum or colon should, in the authors' opinion, only very rarely be necessary. Cutaneous ureterostomy is used only as a last resort in incontinent patients with severe renal damage. The greatest single advance in the management of the malformation has been the two-stage closure of the exstrophic bladder. The authors' experiences in the two-stage closure of 28 patients with ectopia vesicae are described. No selection of patients was practiced. The results obtained, both clinically and by manometry of the operated bladder, are reviewed. The results are moderately satisfactory.

Ureterosigmoidostomy.

Some historical aspects of ureterosigmoidostomy are described, and various techniques are discussed and illustrated. Our own satisfaction with the results when the procedure is done through the open sigmoid colon is expressed. Ureterosigmoidostomy, which has in some surgeons' hands fallen into disuse, will continue to be used and probably should be used more than it is at present. When ureterosigmoidostomy is done meticulous care is important in producing a long submucosal tunnel with direct anastomosis of the ureter to the bowel. Preoperative bowel preparation is mandatory. Patients who have undergone ureterosigmoidostomy should remain on a low chloride diet indefinitely with an adequate supplement of sodium potassium citrate to diminish the dangers of electrolyte imbalance and hyperchloremic acidosis. Careful postoperative management and followup care are vital to success.