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[Plastic repair of the isolated bladder in exstrophy in children]
Insights
This study used sigmoid colon segments for urinary diversion in children with bladder exstrophy, reducing surgeries to one stage. The technique showed adequate intestinal function, preventing complications and suggesting anal electrostimulation for sphincter improvement.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Context:
- Bladder exstrophy is a complex congenital condition requiring reconstructive surgery.
- Urinary diversion is a critical component in managing bladder exstrophy.
- Previous methods often involved multiple surgical stages.
Purpose:
- To evaluate the efficacy of using a sigmoid colon segment for urinary diversion in pediatric bladder exstrophy patients.
- To assess the functional outcomes and potential complications of this surgical technique.
- To determine the suitability of the sigmoid colon for entero-urinary anastomoses.
Summary:
- Fourteen children with bladder exstrophy underwent urinary diversion using a sigmoid colon segment.
- Preoperative bowel preparation reduced the procedure to a single surgical stage.
- Follow-up of 12 patients for 1-3 years revealed adequate sigmoid colon contractile and peristaltic activity, preventing fecal contamination of the entero-urinary anastomosis.
- One patient developed right ureterohydronephrosis.
Impact:
- This approach simplifies surgical management by consolidating procedures into one stage.
- The sigmoid colon segment demonstrated functional viability for urinary diversion, minimizing risks of anastomotic leakage.
- Anal electrostimulation with diadynamic current is proposed as a method to enhance rectal sphincter function in these patients.
Abstract:
Sigmoid colon segment was used to pass the urine through the intestine in 14 children with exstrophy of the bladder. Preoperative management of large intestine helped to reduce the number of operative stages from two to one. 12 patients were followed up from 1 to 3 yrs. Right ureterohydronephrosis of the upper urinary tract was observed in 1 patient. Urodynamic investigation of isolated sigmoid colon segment evidenced of its adequate contractile and peristaltic activity preventing the contact of feces with entero-ureteral anastomoses. To improve the closing ability of rectal sphincter in the above patients anal electrostimulation with diadynamic current can be recommended.