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Bladder Herniation as an Auto-Augmentation Technique in Bladder Exstrophy: Initial Experience in Patients with Small
Shabnam Sabetkish1, Abdol-Mohammad Kajbafzadeh1
1Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
Urology
|February 28, 2020
Summary
This bladder herniation technique safely expands small bladders in patients with bladder exstrophy epispadias complex (BEEC). It increases bladder capacity for successful primary closure, avoiding the need for further bladder augmentation.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Congenital Abnormalities
Background:
- Bladder exstrophy epispadias complex (BEEC) often presents with inadequate bladder plates, posing challenges for surgical repair.
- Achieving sufficient bladder capacity is crucial for successful primary closure and long-term functional outcomes in BEEC patients.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of the bladder plate herniation technique for auto-augmentation in BEEC patients with inadequate bladder plates.
- To assess the potential of this technique to increase bladder capacity, facilitating primary bladder closure and reducing the need for subsequent bladder augmentation.
Main Methods:
- A cohort of ten BEEC patients with inadequate bladder plates underwent bladder plate herniation, involving fixation of the exstrophic bladder above the peritoneal cavity.
- Peritoneal contents were herniated beneath the bladder plate to transfer abdominal pressure for gradual bladder expansion.
- In five patients, inguinal hernia repair was performed concurrently to enhance pressure transfer; bladder capacity was assessed via cystometry and voiding cystourethrogram before and after the procedure.
Main Results:
- The bladder plate herniation technique resulted in significant bladder enlargement during straining/crying, with no reported complications.
- Average bladder capacity increased 2.5 to 3 times within 8 months of follow-up, rendering the bladder suitable for primary closure.
- None of the patients required additional bladder augmentation following the single-stage total BEEC reconstruction.
Conclusions:
- The bladder plate herniation technique is a safe, effective, and feasible option for increasing bladder capacity in BEEC patients with small bladders prior to primary closure.
- This approach enhances the success rate of primary closure and may obviate the need for bladder augmentation in staged reconstructions.
