VOLUME OF SURGERY IN THE PRIMARY CLOSURE OF BLADDER IN CHILDREN WITH BLADDER EXSTROPHY
Y. E. Rudin , Yu. Yu. Sokolov , A. Yu. Rudin , A. S. Kirsanov , N. V. Medvedeva , E. V. Kartseva
Russian Journal of Pediatric Surgery ›› 2020, Vol. 24 ›› Issue (1) : 21 -28.
Introduction. Bladder exstrophy is one of the most complex malformations in pediatric urology. Material and methods. In 1996-2019, 112 children with bladder exstrophy, aged 2 -32 days, had a “primary bladder repair” in St Vladimir Children’s Municipal Clinical Hospital. All children (112) were divided into groups depending on dimensions of the cystic area: large bladder size (over 5 cm) - 39 (34.8%) patients; average size (35-50 mm) - 43 (38.9%); small size (less than 35mm) - 31 children (27.6%). Subgroup “A” - 77 patients (68.7%) were treated in 1996 - 2012, and the primary bladder closure was performed at their neonatal period regardless of the area size. Subgroup “B” - 35 children (31.2%), operated on in 2013-2019, had various volume surgeries depending on clinical manifestations. These groups are homogeneous and comparable in age and manifestations. Results. Complications after surgery were seen in 20 children (25%) from Subgroup “A”: exstrophy relapse - 14 (18%), divergence of bladder neck - 6 (7%). The outcome analysis has shown that the highest rate of exstrophy relapses and cervical divergence was observed in children with microcystis - 15 (57.4%) out of 21. In Subgroup “B”, exstrophy relapse was observed in 1 (2.8%) child with an average bladder size; cervical divergence - in 2 (5.6%) children with an average size and in 2 (5.6%) with microcystis. The number of complications in children with microcystis was reduced from 15 out of 21 children (71%) in Subgroup “A” to 2 out of 10 patients (20%) in Subgroup “B”. Conclusion. A differentiated approach to the choice of surgery volume and proposed additional measures lead to better bladder growth and better urine retention after the first surgery.
bladder exstrophy / bladder plasty / primary closure of bladder / microcystis / bladder size / urine retention
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