Combined bladder neck, urethral and penile reconstruction in boys with the exstrophy-epispadias complex.

OBJECTIVE: To describe a one-stage combined bladder neck, urethral and penile reconstruction for achieving urinary continence and creating a penis with good cosmesis and function in boys with the exstrophy-epispadias complex. PATIENTS AND METHODS: Seventy-three boys underwent the combined procedure, including 36 after classic bladder exstrophy closure and 37 with epispadias. All were completely incontinent at the time of combined reconstruction. The bladder capacity just before surgery was 70-180 mL and was greater in those with epispadias. The boys were 2.5-11 years old, with those in the exstrophy group being slightly older. RESULTS: Thirty-three boys (89%) with epispadias were completely continent during the day but 15 had episodes of nocturnal enuresis. Of boys with classic exstrophy, 27 (75%) were continent during the day but nine had occasional nocturnal enuresis. Eleven boys required intermittent catheterization, which they found easy to perform. In seven boys (10%) a urethrocutaneous fistula or urethral stricture developed. CONCLUSIONS: Combined bladder neck, urethral and penile reconstruction can be carried out as a one-stage procedure in selected patients with adequate bladder capacity. Reconstruction of the whole length of the urethra facilitates intermittent catheterization.

Complete duplication of the bladder, urethra, vagina, and uterus in girls.

UNLABELLED: OBJECTIVES. To present our experience with 3 girls with complete duplication of the bladder, urethra, vagina, and uterus, a very rare anomaly, and review published reports. Associated anomalies in these cases represent a wide spectrum. METHODS: We report 3 girls with complete duplication of the bladder, urethra, vagina, and uterus. The associated anomalies were different in each child. The first patient had a symphysis diastasis creating an abdominal hernia with two bladders dislocated into this space. The second patient had anal atresia with colon duplication. The third had cloacal exstrophy with one opened bladder and a second closed, with persistent urogenital sinus. Each patient was carefully evaluated, but the anatomy in 2 patients was not completely defined until surgical exploration. RESULTS: Each girl underwent surgical repair. In the first patient, iliac osteotomy, approximation of the symphysis pubis, and excision of the hernia was done. In the second, excision of the common wall between the two descending colons and posterior sagittal anorectoplasty were performed. In the third patient, staged reconstruction of the cloacal exstrophy with anastomosis of the bladders and vaginas was done. CONCLUSIONS: Complete duplication of the urogenital system in girls is associated with different anomalies. Which surgical procedures will be required depends on the multiple anatomic variables.

[Complete duplication of the urogenital system in girls]. / Calkowite zdwojenie ukladu moczowo-plciowego u dziewczynek.

The authors report 3 girls with complete duplication of the bladder, urethra, vagina and uterus. Defect's anatomy and associated anomalies are described. In support of the literature therapeutic procedure is discussed, which must be individualized in each case.

Genital reconstruction.

Genital reconstruction is necessary in various types of congenital malformations. Although various surgical procedures may be used depending on the anomaly, the basic principles are the same. Three groups of pathology are discussed: hypospadias, ambiguous genitalia and exstrophy-epispadias complex. Progress continues to be made in modifying older techniques and creating new ones. Some investigators have focused on pain control and dressing materials. There is still much work to be done in this challenging area.