THE URINARY BLADDER DRAINAGE AFTER THE RECONSTRUCTIVE AND PLASTIC OPERATIONS IN CHILDREN WITH BLADDER EXTROPHY

Abstract

THE AIM. To create an easy and simple method of urinary bladder drainage (UB) after the reconstructive and plastic operations on extrophy of bladder (EUB). PATIENTS AND METHODS. The results of the operations on EUB in 18 children from the age of 1 month to 3 years old were studied. Independently on the state of mucous tunic and the size of the UB wall, to all patients was performed single-step cistosphincteroplasty. For the urinary bladder drainage we used a four channel catheter of our construction. Our construction guards from clotting by mucosal-excudative discharge, and by that means prevents obturation, which increases the efficiency of drainage and dependability of the device. RESULTS. In the early post operative period 4 patients had urinary fistulas, vesicle - 2 patients, vesicocervical - 1 patients and urethra-cutaneous - 1, which in total amounted to 22,2 %. Vesicouretheral reflux was noted in 2 children (11,1%). Chronic pyelonephritis developed in 6 patients (33,3 %). Our method of drainage in general did not differ from the standard methods. Although we refused from the catheterization of urether. In our patients significantly decreased the possibility of the formation of the uerthercutanous fistulas, vesicoureteral reflux, and chronic pyelonephritis. CONCLUSION. The refusal from long-term drainage of the UB and urether during the reconstructive and plastic surgery, regarding EUB, reliably decreases the formation of vesicoureteral reflux, chronic pyelonephritis and cystitis. The use of our catheter during reconstructive and plastic surgeries now a days is optimal method and decreases the rate of complications. Relatively high frequency of urinary fistulas during cistosphincteroplasty needs further improvement in drainage methods and the plastics of the front abdominal wall, UB, UB cervix and urethra.