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[Continent enterocystoplasty in urinary bladder exstrophy]

H Stefan1

  • 1Urologická klinika FN, Hradec Králové.

Rozhledy V Chirurgii : Mesicnik Ceskoslovenske Chirurgicke Spolecnosti
|September 1, 1994
PubMed
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Continent enterocystoplasty effectively manages failed bladder exstrophy reconstruction by creating larger, low-pressure reservoirs. This surgical technique improves bladder capacity and offers an alternative to traditional urinary diversion methods.

Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Context:

  • Bladder exstrophy reconstruction often fails, leading to inadequate bladder capacity, poor compliance, and incontinence.
  • Previous reconstructive attempts may necessitate alternative surgical solutions.

Purpose:

  • To evaluate the efficacy of continent enterocystoplasty in patients with failed bladder exstrophy reconstruction.
  • To assess the functional outcomes and safety of using bowel segments to create augmented bladder reservoirs.

Summary:

  • Five patients (2 girls, 3 boys) underwent continent enterocystoplasty using detubularized bowel (ileocecum or ascending colon) and bladder remnants.
  • Procedures included vesical neck reconstruction (Young-Dees-Leadbetter) and ureteral reimplantation (Goodwin technique). The Mitrofanoff mechanism was used in three patients.

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  • Preoperative bladder capacity (12-100 mL) significantly increased post-surgery (mean 300 mL, max 550 mL). Four patients require clean intermittent catheterization; one voids spontaneously.
  • Impact:

    • Continent enterocystoplasty demonstrates efficacy as an alternative to urinary diversion for failed bladder exstrophy.
    • Stable renal function and decreased hydronephrosis were observed in the short-term follow-up.
    • This approach offers improved bladder capacity and continence in complex pediatric urological cases.