NEW METHODS OF SURGICAL CORRECTION IN EXSTROPHY OF THE URINARY BLADDER IN CHILDREN

Abstract

THE AIM of the investigation was to substantiate new methods of operative interventions in cases of exstrophy of the urinary bladder. PATIENTS AND METHODS. Results of 45 operations in children with exstrophy of the urinary bladder were analyzed. Modified methods were used for elimination of defects of the urinary bladder, anterior abdominal wall and share bones. The patients were divided into 3 groups: the first group consisted of 16 patients; in them a one-stage operation was performed for bringing near the share bones without osteotomy. In the second group (22 patients) cystosphincterourethroplasty was made for bringing near symphys pubis without osteotomy and with transversal suture of aponeurosis of the external oblique and rectal abdominal muscles. In the third group (7 patients) a one-stage operation was performed for bringing near the share bones without osteotomy in the clinic’s modification. RESULTS. High incidence of different complications was noted in the first group; there were 15 (93.75%) complications in the early postoperative period, in the later period there were 19 (118.75%). In the second group there were no complications in the early postoperative period, and in the late period there were only 12 complications (54.54%). In the patients of the third group operated by the new modified method of bringing share bones nearer there were no complications in the early postoperative period. CONCLUSION. Early one-stage operative correction of the defect is indicated in children with exstrophy of the urinary bladder. Effectiveness of this technique is in direct proportion to the patient’s age and is the main cause of successful reconstructive plastic operations for exstrophy of the urinary bladder. All medical measures for exstrophy of the urinary bladder must be completed by the preschool age. Diversion of urine into intestine should be used but after failed reconstructive-plastic operations.