Delayed exstrophy repair (DER) does not compromise initial bladder development

Ferrara, Francesco; Dickson, Alan P.; Fishwick, Janet; Vashisht, Rita; Khan, Tahair; Cervellione, Raimondo M.

doi:10.1016/j.jpurol.2013.10.026

Cited by 24 publications

(4 citation statements)

References 13 publications

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“…With much of the recent interest focused on improved cosmesis after the primary bladder reconstruction, little attention has been dedicated to reduce the size and number of polyps and prevent further inflammation before the operation. In several studies, it has been demonstrated that the application of a barrier dressing and frequent irrigation can preserve the bladder mucosa ( 11 , 12 ). In one study in 2015, it has been demonstrated that plastic coverage during all follow-up period prevented the thickening of the mucosa and polyp formation and prevented prolonged environmental exposure of the bladder mucosa ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size

Sabetkish

Kajbafzadeh

2018

Int. braz j urol.

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ObjectiveTo assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstro- phy cases, and to compare the results with the application of low-barrier wrap.Materials and MethodsEight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps.ResultsThe high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps' size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC.ConclusionPolyps' size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more “exstrophy-friendly”.

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Section: Discussionmentioning

confidence: 99%

Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size

Sabetkish

Kajbafzadeh

2018

Int. braz j urol.

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“…При этом выполнение стандартного протокола функционального закрытия не может быть осуществлено на мочевом пузыре малых размеров, с фиброзно-измененной стенкой без необходимой эластичности и покрытой полипозными разрастаниями слизистой [17,21]. В таком случае у пациентов с ЭМП и микроцистисом оперативное лечение может быть отложено на 6-12 мес, так как отсрочка первичного закрытия по показаниям не ставит под угрозу рост мочевого пузыря, в то время как решение закрыть пузырную площадку в неподходящих условиях может привести к расхождению швов и недержанию мочи в будущем [18,32,33]. Если мочевой пузырь не увеличивается до достаточного размера для закрытия через 6-12 мес, могут рассматриваться другие варианты лечения, включающие иссечение мочевого пузыря с формированием кишечного кондуита.…”

Section: диагностика и лечениеunclassified

Anatomical features of the malformation, methods and results of bladder exstrophy primary closure. Literature review

Rudin

Sokolov

2023

Androl. genit. hir.

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Экстрофия мочевого пузыря (ЭМП) -сложный сочетанный порок развития органов мочеполовой системы, методы лечения которого до конца не разработаны. Материалы и методы. При написании обзора литературы были использованы материалы, посвященные проблеме ЭМП, найденные в базах данных PubMed, еLIBRARY (российская научная электронная библиотека), Scopus, Medline, EMBASE, на веб-сайтах и в журналах зарубежных и отечественных профессиональных ассоциаций. Результаты. Множественные анатомические особенности строения органов и целых систем делают ЭМП одним из самых сложнокорригируемых врожденных пороков в области детской урологии, требующих комплексного, системного подхода к диагностике и лечению. В работе отражены ключевые, по нашему мнению, аспекты авторских операций Kelly, Mainz, подходов Schrott-Erlangen, CPRE, MSRE, а также взгляды ряда авторов на остеотомию. Заключение. Изобилие техник первичного закрытия ЭМП и различия во взглядах многих авторов на необходимый объем оперативного вмешательства, представленные в данном обзоре литературы, являются неоспоримым доказательством актуальности проблемы.

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“…In comparison to the specimens of newborns with BE (5) active inflammation was more common but fibrosis and more severe inflammation was not more frequent in delayed closure. Ferrara et al suggested that some microscopic changes, such as squamous metaplasia, reverse to normal after bladder closure (6, 7). Literature on mucosal changes in early life in BE is rare.…”

Section: Timingmentioning

confidence: 99%

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

Promm¹,

Roêsch²

2019

Front. Pediatr.

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Although enormous effort has been made to further improve the operative techniques worldwide, the management of bladder exstrophy (BE) remains one of the most significant challenges in pediatric urology. Today it is universally agreed that successful and gentle initial bladder closure is decisive for favorable long-term outcome with regard to bladder capacity, renal function and continence. Due to a number of reasons, including a lack of comparable multicenter studies, a range of concepts is currently used to achieve successful primary closure. We review the literature of the last 15 years on the current concepts of bladder exstrophy repair with regard to the time of primary closure (initial vs. delayed closure), the concepts of primary closure (single-stage vs. staged approach; without osteotomy vs. osteotomy) and their outcomes. There is a worldwide lack of multicenter outcome studies with adequate patient numbers and precisely defined outcome parameters, based on the use of validated instruments. The modern staged repair (MRSE) in different variations, the complete primary reconstruction of exstrophy (CPRE), and the radical soft-tissue mobilization (RSTM) had been the most extensively studied and reported procedures. These major concepts are obligatory stable now for more than 20 years. Nevertheless, there are still a lot of open-ended questions e.g., on the potential for development of the bladder template, on continence, on long-term orthopedic outcome, on sexuality and fertility and on quality of life. Management of BE remains difficult and controversial. Further, clinical research should focus on multi-institutional collaborative trials to determine the optimal approach.

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Delayed exstrophy repair (DER) does not compromise initial bladder development

Cited by 24 publications

References 13 publications

Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size

Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size

Anatomical features of the malformation, methods and results of bladder exstrophy primary closure. Literature review

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

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