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11–14 APRIL, 2018, HELSINKI, FINLAND
S17: EXTROPHY-EPISPADIAS
COMPLEX 1
Moderators: Ashraf Hafez (Egypt), Wolfgang Rösch (Germany)
ESPU Meeting on Friday 13, April 2018, 14:24–15:02
14:24–14:27
S17-1 (PP)
★
ONE-STAGE COMBINED DELAYED BLADDER CLOSURE
AND KELLY RADICAL SOFT-TISSUE MOBILISATION
FOR BLADDER EXSTROPHY
Sébastien FARAJ
1
, Sajid SULTAN
2
, Georges AUDRY
3
, Yves HELOURY
4
, Philip
RANSLEY
2
and Marc-David LECLAIR
1
1) Hôpital Mère-Enfant, Chirurgie Infantile, Nantes, FRANCE - 2) Sindh Institute of Urology & Transplantation, Pediatric
Urology, Karachi, PAKISTAN - 3) Hôpital Trousseau, Chirurgie Pédiatrique, Paris, FRANCE - 4) Royal Children Hospital,
Pediatric Urology, Melbourne, AUSTRALIA
PURPOSE
The radical soft-tissue mobilisation (RSTM or Kelly repair) for bladder exstrophy (BE) has been
so far reported as part of a two-stage strategy after successful neonatal closure. With the emerg-
ing concept of delayed closure of BE, we investigated the feasibility of one-stage delayed bladder
closure combined with RSTM in infants with classical BE.
MATERIAL AND METHODS
Prospective inclusion and follow-up of consecutive newborns with BE in an 18-month period
(2016–2017). Repair was performed (ideally at the age of 3 months) by the same surgeon at
4 collaborating institutions.
Technique included RSTM with ureteric reimplant, cervicoplasty, penile reconstruction, and bladder
closure, without pelvic osteotomies. Midline closure was performed with transposition of rectus
abdominis muscles whenever necessary. Postoperative immobilisation was maintained for 21 days.
Postoperative follow-up was based on clinical examination and renal US at 1–3–6–12 months,
and EUA+endoscopy at 4 and 12 months postoperatively.
Main outcome criteria was postoperative bladder dehiscence at 3 months. Secondary outcome
measures included urethrocutaneous fistula, stenosis, and UTIs.
RESULTS
11 children (8 M/3F) were included in this study and underwent surgery at a median age of 15 weeks
[2–32] for those with intentional delayed surgery (n=8) and 43 wks [14–104] for those presenting
late (n=3). Median follow-up was 10 months [4–20].
No case of bladder dehiscence was observed after all cases reached the 3 months end-point. Three
children presented postoperative urethro-cutaneous fistula, all of which closed spontaneously in
3–6 weeks. One boy presented symptomatic urethral stenosis (orchi-epididymitis and UTIs) suc-
cessfully treated with 3 sessions of endoscopic balloon dilatation (follow-up of 11 months after the
last session). No case of glans ischemia was observed. Minor skin dehiscence was successfully
treated conservatively in 3 cases.