Aesthetic aspects of abdominal wall and external genital reconstructive surgery in bladder exstrophy-epispadias complex

VanderBrink, Brian A.; Stock, Jeffrey A.; Hanna, Moneer K.

doi:10.1007/s11934-006-0075-0

Cited by 10 publications

(6 citation statements)

References 79 publications

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“…7,8 (4) Multiple groups of deep fasciocutaneous flaps had reliable blood supply, which met the requirements of multilevel repair of abdominal wall, and the shape of abdominal wall was good after operation. (5) The implementation of multiple groups of flaps in vulvoplasty contributes to achieving a fuller postoperative female aesthetic appearance and enhances overall recovery outcomes. In addition, this approach facilitates the reconstruction of the lower abdomen shape in male patients, mitigating the risk of significant complications such as urinary incontinence.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of the Efficacy of Multilayered Repair and Reconstruction Using Combined Tissue Pedicle Flaps for Abdominal Wall Defects in Adult Bladder Exstrophy Patients

Azhati,

Dilixiati,

Reheman

et al. 2024

Ann Plast Surg

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Objective In this study, we conducted a retrospective analysis of cases involving adult classic bladder exstrophy (CBE) accompanied by the absence of the abdominal wall. Specifically, we focused on the utilization of multilayer flaps for reconstructive purposes. In addition, we aimed to share our clinical treatment experience pertaining to similar challenges, thereby providing valuable insights to complement the surgical management of this rare disease. Methods We conducted a retrospective analysis of 12 adult patients diagnosed with CBE who underwent initial treatment between June 2013 and January 2020. All patients underwent multilayer reconstruction to address their abdominal wall defects. This involved utilizing shallow flaps derived from the superficial fascia of the abdomen and incorporating myofascial flaps composed of the anterior sheath of the rectus abdominis and aponeurosis of the external oblique muscle. The flap sizes ranged from 9 × 11 cm to 13 × 15 cm. Results Abdominal wall reconstruction in the 12 patients with CBE resulted in an absence of wound dehiscence recurrence, urinary obstruction, or urinary tract infection. All patients expressed satisfaction with the aesthetic outcome of their abdominal wall based on self-evaluation. They reported a successful resumption of normal life and work activities without experiencing any restrictions. The married patients expressed contentment with their sexual function. Conclusion The utilization of a multilayered reconstruction technique involving multiple flaps in adults with congenital CBE allows for successful restoration of urinary function, as well as the attainment of sufficient abdominal wall strength to support daily life and work activities, while preserving sexual function. However, it is important to approach the evaluation of surgical outcomes with caution because of the rarity of this condition and the lack of objective assessment measures.

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Section: Discussionmentioning

confidence: 99%

An Analysis of the Efficacy of Multilayered Repair and Reconstruction Using Combined Tissue Pedicle Flaps for Abdominal Wall Defects in Adult Bladder Exstrophy Patients

Azhati,

Dilixiati,

Reheman

et al. 2024

Ann Plast Surg

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“…The traditional methods for repairing such defects mainly involve the use of various skin flaps alone or in combination with peripheral muscle tissue flaps. [9][10][11][12] These surgical procedures are relatively complex and may lead to complications, resulting in large wounds and significantly prolonging hospitalization time. Another approach is to perform an osteotomy, which can facilitate easier repair of the anterior abdominal wall defect.…”

Section: Discussionmentioning

confidence: 99%

TopClosure® tension-relief system for immediate primary abdominal defect repair in an adult patient with bladder exstrophy

Zhu

Tong

et al. 2019

J Int Med Res

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Bladder exstrophy during adulthood is a rare deformity. A major surgical challenge encountered in bladder exstrophy cases is the repair of an anterior abdominal wall defect. The TopClosure V R tension-relief system (TRS) is a simple and practical skin stretching and wound closure-secure system that can be useful in treating patients with bladder exstrophy. A 61-year-old man presented with a congenital bladder valgus and epispadias. The dorsal side of the penis was split. The patient underwent valgus cystectomy, bilateral ureteral skin stoma creation, and primary closure of the large defect of the anterior abdominal wall using the TopClosure V R TRS. At the 1-year follow-up after surgery, the patient had recovered well, and there were no indications of major complications. Utilization of the TopClosure V R TRS to repair the large abdominal defect is an innovative method for abdominal reconstruction. The TopClosure V R TRS reduces operative time and the duration of hospital stay and improves wound aesthetics.

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“…Long-term follow-up of patients born with classical bladder EEC reveals that many of them suffer from poor self-image, and aesthetic aspects of the genitalia and lower abdomen acquire greater significance with age. [ 14 ] Appreciation of the aesthetic outcomes of the external genitalia was possible in two patients, one male and one female. Despite the satisfying appearance of the penis [Figures 1 and 2 ], the adolescent and his mother requested penis enlargement.…”

Section: Discussionmentioning

confidence: 99%

“…Attention to cosmetics during abdominal wall and genital reconstruction for EEC helps to improve a patient's perception of body image and self-esteem. [ 14 15 16 ] In the female, the clitoris is bipartite with an unsightly appearance of the labia majora and minora [ Figure 3 ]. The unsightly appearance of the external genitalia may require mons plasty.…”

Section: Discussionmentioning

confidence: 99%

Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias′s management

Kouamé¹,

Kouamé²,

Sounkere³

et al. 2015

Afr J Paediatr Surg

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Background:Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes.Materials and Methods:We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis.Results:Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof.Conclusion:When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length.

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Aesthetic aspects of abdominal wall and external genital reconstructive surgery in bladder exstrophy-epispadias complex

Cited by 10 publications

References 79 publications

An Analysis of the Efficacy of Multilayered Repair and Reconstruction Using Combined Tissue Pedicle Flaps for Abdominal Wall Defects in Adult Bladder Exstrophy Patients

An Analysis of the Efficacy of Multilayered Repair and Reconstruction Using Combined Tissue Pedicle Flaps for Abdominal Wall Defects in Adult Bladder Exstrophy Patients

TopClosure® tension-relief system for immediate primary abdominal defect repair in an adult patient with bladder exstrophy

Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias′s management

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