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Gracilis muscle sling for select incontinent "bladder exstrophy cripples"
M D Gershbaum1, J A Stock, M K Hanna
1Department of Urology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
The Journal of Urology
|May 24, 2001
Summary
This study shows that using a vascularized gracilis muscle flap to wrap the bladder neck in children with bladder exstrophy can successfully restore continence. This technique offers a viable solution for complex cases with compromised tissue quality.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Tissue Engineering
Background:
- Bladder exstrophy reconstruction can fail, particularly after multiple surgeries.
- Tissue compromise at the bladder neck limits options for urinary continence.
- Conventional procedures are often unsuitable for severely damaged bladder necks.
Purpose of the Study:
- To evaluate the efficacy of a vascularized gracilis muscle flap for bladder neck reconstruction in children with bladder exstrophy.
- To assess the use of gracilis muscle transfer in cases of failed previous reconstructions.
Main Methods:
- A vascularized gracilis muscle flap was used to encircle the bladder neck in 5 children with bladder exstrophy.
- Three patients had multiple failed reconstructions; two had failed bladder closure.
- A one-stage repair including bladder augmentation and ureteroneocystotomy was performed in two cases.
Main Results:
- All 5 children achieved dryness between clean intermittent catheterization.
- Postoperative complications included UTIs, stomal stenosis, small bowel obstruction, and bladder stones.
- No complications were attributed to the gracilis muscle flap transfer.
Conclusions:
- Vascularized gracilis muscle flap is effective for wrapping compromised bladder necks in incontinent patients with bladder exstrophy.
- The flap creates a competent sling, increasing outlet resistance and enabling dry intervals.
- Long-term follow-up (up to 13 years) shows satisfactory results.