[The treatment of bladder exstrophy]

The results of treatment of 41 children with vesical exstrophy were analysed. Four types of surgeries were performed: 1) transplantation of Lieutaud's triangle into the sigmoid (n = 19); 2) its transplantation into the semi-isolated part of the sigmoid (n = 7); 3) ureteral transplantation into the sigmoid (n = 3); 4) the formation of the urinary bladder and ureter from the adjacent tissues (n = 12). In the first group 2 children died, 6 patients had no clinical signs of chronic renal or ureteral inflammation for the period of 5-17 years, the remaining 11 patients had pyelonephritis. In the second group 5 children were apparently healthy for 1-3 years after the operation, one child developed pyelonephritis, one child died from pneumonia. In the third group 2 patients were apparently healthy 1.5-2 years after the surgery, 1 child developed pyelonephritis. A great number of complications such as sutural incompetence followed by fistulization or enuresis made the authors avoid the fourth type. Thus, while forming an urointestinal anastomosis, preference is given to transplantation of Lieutaud's triangle or ureters proper into the semi-isolated segment according to the antireflux methods, if there are strictures in their distal portions.