Abstract
Purpose
Presentation of bladder exstrophy epispadias complex (BEEC) during adulthood is rare. A major surgical challenge encountered in adults with BEEC is the closure of the anterior abdominal wall defect. In this case series we report our experience with the abdominal closure without osteotomy.
Materials and methods
Five adult male patients with BEEC were managed at our center. None of the patients had any prior attempts of surgical correction. A right renal tumor was incidentally discovered in one patient and a right partial nephrectomy was performed. All patients underwent urinary diversion and abdominal wall closure at the same operative setting except one. Cystectomy was performed in two patients while the vesical plate muscular coat was utilized for providing support to the anterior abdominal wall in the other three patients. One patient underwent an ileal conduit, while the other patients underwent continent cutaneous diversion. None of our patients underwent osteotomy.
Results
Follow-up ranged from 6 to 52 months (mean = 31). Patients who underwent continent cutaneous diversion were continent by day and night. One patient had wound infection and partial disruption and secondary sutures were performed. One patient developed stomal stenosis and was managed by stomal dilatation. All patients showed marked satisfaction with their body image following surgery.
Conclusion
Management of BEEC in adults is challenging. Utilization of the vesical plate muscular coat for supporting the anterior abdominal wall is a reliable method for abdominal reconstruction. Urinary diversion and abdominal wall closure in one surgical procedure without osteotomy is feasible.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lancaster PAL (1987) Epidemiology of bladder exstrophy: a communication from the international clearinghouse for birth defects monitoring systems. Teratology 36:221–226
Gearhart JP, Mathews R (2000) Penile reconstruction combined with bladder closure in the management of classic bladder exstrophy: illustration of technique. Urology 55:764–770
Gulati P, Yadav SP, Sharma U (1997) Management of bladder exstrophy in adulthood: report of 2 cases. J Urol 157:947–949
Quattara K, Daffe S, Timberly A (1992) Exstrophy of bladder in adults. J Urol 98:64–65
Ozdiler E, Sarica K, Baltaci S (1996) A 49-year-old women with noncomplicated exstrophy of bladder. Int Urol Nephrol 28:747–750
Abol-Enein H, Ghoneim MA (1999) Serous-lined extramural ileal valve: a new continent urinary outlet. J Urol 161:786–791
Gearhart JP, Ben-Chaim J, Jeffs RD (1995) Criteria for the prenatal diagnosis of classic bladder exstrophy. Obstet Gynecol 85:961–964
Matsuda T, Okada Y, Takeuchi H, Yoshida O (1987) Adult female exstrophy of bladder treated with a Koch continent reservoir: report of a case. Urol Int 42:74–76
Pathak H, Mahajan R, Ali N et al (2001) Bladder preservation in adult classic exstrophy: early results of four patients. Urology 57:906–910
Rieder JM, Parsons JK, Gearhart JP, Schoenberg M (2006) Primary squamous cell carcinoma in unreconstructed exstrophic bladder. Urology 67:199
Smeulders N, Woodhouse C (2001) Neoplasia in adult exstrophy patients. BJU Int 87:623–628
Paletta CE, Huang DB, Dehghan K (1999) The use of tissue expanders in abdominal wall reconstruction. Ann Plast Surg 42:259–265
Conflict of interest statement
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mansour, A.M., Sarhan, O.M., Helmy, T.E. et al. Management of bladder exstrophy epispadias complex in adults: is abdominal closure possible without osteotomy?. World J Urol 28, 199–204 (2010). https://doi.org/10.1007/s00345-009-0436-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-009-0436-7