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Ileal nipple for continence in cloacal exstrophy
1Department of Surgery, Children's Hospital, Boston, Massachusetts.
Insights
A catheterizable bowel nipple can help children with cloacal exstrophy achieve urinary continence. This surgical option offers a solution when local tissues are insufficient for bladder neck and urethra creation.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Congenital Abnormalities
Background:
- Cloacal exstrophy presents significant challenges in urinary tract reconstruction.
- Urinary incontinence is a common complication requiring innovative surgical solutions.
Observation:
- Seven patients (2-17 years) with cloacal exstrophy underwent bladder augmentation and creation of a small bowel nipple.
- Augmentation utilized small bowel, gastric tissue, or both, with evolving techniques over time.
Findings:
- Six out of seven patients achieved complete dryness and managed bladder emptying via intermittent self-catheterization.
- One case failed due to nipple infarction, necessitating reoperation.
Implications:
- A reversed, catheterizable bowel nipple is a viable option for bladder outlet reconstruction in cloacal exstrophy.
- This technique addresses cases with insufficient local tissue for bladder neck and urethra formation.
- Further evaluation and potential reoperation are considered for treatment failures.
Abstract:
Since 1985, 7 children 2 to 17 years old with urinary incontinence from cloacal exstrophy underwent bladder augmentation and creation of a small bowel nipple at the bladder outlet. There were 3 genetic female and 4 genetic male patients being reared in the female role. In 3 early cases augmentation was done with small bowel, while gastric augmentation was used in 3 later cases and 1 had both types. Six patients became completely dry and they empty by intermittent self-catheterization. In the youngest patient the operation failed because the nipple became infarcted and disappeared. Reoperation will be performed after at least 1 year has passed. In cloacal exstrophy if there is insufficient local tissue to create a bladder neck and urethra, a reversed, catheterizable bowel nipple may be an option to consider.