Bladder Exstrophy: Repair Surgical Techniques and Cases

This video is about bladder exstrophy. The exstrophy-epispadias complex comprises a spectrum of congenital abnormalities that includes classic bladder exstrophy, epispadias, cloacal exstrophy, and several variants.

2 surgical techniques are following:
The 1st one is staged functional closure for classic bladder exstrophy is a series of the following operations:
- Initial bladder closure is completed within 72 hours of birth. If delayed, pelvic osteotomies are required to facilitate successful closure of the abdominal wall and to allow the bladder to lie within a closed and supportive pelvic ring.
- Epispadias repair with urethroplasty at age 12-18 months allows enough increase in bladder outlet resistance to improve the bladder capacity.
- Bladder neck reconstruction at age of 4 years allows continence and correction of vesicoureteral reflux. Multiple modifications have been proposed.

The 2nd technique is complete primary repair for classic bladder exstrophy. It is a relatively newer approach to exstrophy closure, when primary bladder closure, urethroplasty, and genital reconstruction are performed in a single stage in newborns.

Reconstruction of exstrophy-epispadias complex remains one of the greatest challenges facing the pediatric urologist. Goals of therapy include provision of urinary continence with preservation of renal function and reconstruction of functional and cosmetically acceptable genitalia. Creation of a neo-umbilicus is also important to many of these patients.