Surgical Management of Bladder Exstrophy Complex
Summary
Bladder exstrophy complex is a congenital anomaly characterised by eversion of the bladder through a defect in the lower abdominal wall, accompanied by varying degrees of pelvic bone separation, genital malformation and urinary tract dysfunction. Surgical management aims to achieve secure closure of the bladder and abdominal wall, reconstruct urinary and genital anatomy, preserve renal function and establish continence, while addressing orthopaedic alignment and cosmesis. Approaches range from staged repairs—where bladder closure, bladder neck reconstruction and epispadias repair are undertaken in separate operations—to single-stage techniques that combine all reconstructive steps in one operative session. Pelvic osteotomies are frequently employed to mobilise the pelvic ring and reduce tension on soft tissues. Bladder neck reconstruction and augmentation procedures enhance outlet resistance and storage capacity. Long-term follow-up encompasses assessment of continence, sexual function, psychosocial development and quality of life within a multidisciplinary framework.
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Surgical Management of Bladder Exstrophy Complex publication trend
The graph below shows the total number of articles in surgical management of bladder exstrophy complex across all publications each year (not limited to Nature Index journals).
Technical terms
Primary closure: Initial surgical approximation of the bladder plate and lower abdominal wall, typically performed in the neonatal period.
Staged repair: A reconstructive strategy in which bladder closure, bladder-neck reconstruction and epispadias correction are carried out in separate operations.
Single-stage reconstruction: A comprehensive surgical procedure combining bladder closure, neourethroplasty and abdominal wall repair in one session.
Pelvic osteotomy: Surgical division of the pelvic bones to reduce tension on reconstructed soft tissues and facilitate approximation of the pubic symphysis.
Neourethroplasty: Creation of a functional urethra, often using flap techniques, to restore urinary continence and normal voiding pathways.
Bladder augmentation: Enlargement of bladder capacity using bowel segments or tissue grafts to improve storage and reduce outlet pressure.
References
- Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut. Frontiers in Pediatrics (2019).
- The Exstrophy-epispadias complex. Orphanet Journal of Rare Diseases (2009).
- Modern Management of the Exstrophy‐Epispadias Complex. Surgery Research and Practice (2014).
- Urological, Sexual, and Quality of Life Evaluation of Adult Patients With Exstrophy-Epispadias Complex: Long-term Results From a Dutch Cohort. Urology (2019).
- One - staged reconstruction of bladder exstrophy in male patients: long - term follow-up outcomes. International braz j urol (2017).
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