Use of muscle pedicle flaps for failed bladder neck closure in the exstrophy spectrum

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• 作者：Jason E. Michaud^a ; ^{jmichau4@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Joan S. Ko^b ; Kathy Lue^a ; Heather N. Di Carlo^a ; Richard J. Redett^b ; John P. Gearhart^a
• 关键词：Bladder exstrophy ; Urinary incontinence ; Urinary diversion ; Urologic surgical procedures
• 刊名：Journal of Pediatric Urology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：12
• 期：5
• 页码：289.e1-289.e5
• 全文大小：709 K

文摘

The authors have reviewed the use of muscle pedicle flaps for the treatment of failed bladder neck closure in exstrophy spectrum patients.

Methods

A retrospective review of all exstrophy spectrum patients who underwent continence procedures with the use of muscle pedicle flaps at our institution during the last 15 years was performed. Patient characteristics, surgical history, and outcomes, including complications, continence, morbidity, and infection, were assessed. The authors utilized muscle pedicle flaps in eight exstrophy patients, including four patients with classic bladder exstrophy and four patients with cloacal exstrophy. Seven of eight patients had failed at least one prior bladder neck closure, and they had undergone a median of three prior urologic procedures. To achieve continence, five rectus muscle flaps and three gracilis muscle flaps were utilized in combination with bladder neck closure.

Results

There were no major intraoperative or postoperative complications. All patients were initially continent, and after a median follow-up of 18.7 months seven of eight patients were continent. One patient required continent urinary stoma revision and one patient developed perineal incontinence after perineal trauma. No patients required revision of, or additional, continence procedures at the bladder neck.

Discussion

The use of pedicle muscle flaps appears to be a safe and feasible option for exstrophy spectrum patients with failed bladder neck closure. Although achieving continence can be difficult in this population, use of muscle flaps and bladder neck closure is a viable and effective option in this challenging subset of patients.