The Treatment of Ectopia Vesicae

Trendelenburg, Friedrich

doi:10.1097/00000658-190608000-00013

Cited by 75 publications

(6 citation statements)

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“…In 1853, an attempt was made to close the bladder but the patient died from peritonitis [5]. Further attempts followed, but it was Trendelenburg in 1906 [6] who noted that to medialize midline structures in exstrophy by bringing the pubic bones into apposition would bring greater success to closure attempts. However, few attempts were made to provide a continent closure of the bladder until 1942 [1] and most cases were dealt with by ureterosigmoidostomy and cystectomy [7].…”

Section: Discussionmentioning

confidence: 99%

Coping with bladder exstrophy: diverse results from early attempts at functional urinary tract surgery

Baird¹,

Sanders²,

Woolfenden³

et al. 2004

BJU International

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OBJECTIVESTo report the long-term surgical outcome in a group of patients with bladder exstrophy treated from 1960 to 1982, and to assess physical health, social integration and sexual function, as attempts at functional closure during the development of this surgery resulted in patients with differing surgical status of the genitourinary organs. PATIENTS AND METHODSA review of medical record archives revealed 36 patients; of these, seven had died, six were untraceable and six declined to participate, leaving 15 evaluable subjects (seven men and eight women, mean age at follow-up, 35 years). Data were collected from medical records and direct interviews were conducted using a semi-structured questionnaire, after obtaining informed consent. The Short Form-36 (SF-36) v2 Health Survey instrument was used to assess health and well-being. RESULTSThree patients have retained the use of their bladder, and 11 had initial bladder closure but required (at a mean age of 3.1 years) various urinary diversions. Eight patients had a pelvic osteotomy. Of 27 functioning renal units, 25 are in reasonable to good condition. Six men and six women had genital reconstruction.Four men are capable of penetrative intercourse and ejaculate; six women manage penetrative intercourse and five have orgasms. All patients attended mainstream school and 13 achieved examination success. Nine patients took vocational training and 11 work full-time. Five patients are married and five are in long-term relationships. Two men have achieved three pregnancies and one women has had a child. The mean total SF-36 score (maximum 3600) was 2763 in men and 2235 in women. CONCLUSIONSSurgery for bladder exstrophy has been developing for more than 40 years and the legacy of early attempts at functional closure is a population of adults who have a diversity of lower urinary tracts, good preservation of renal function overall and acceptable sexual function. They are usually robust, healthy and well-adjusted individuals functioning well in society, often in full-time employment and long-term relationships. Adolescent followup must be clearly focused, incorporating a multidisciplinary team approach to facilitate a seamless transition into adulthood. KEYWORDSbladder exstrophy, reconstruction, function, outcome, follow up Authors from Liverpool address the issue of quality of life in exstrophy patients, and assess the long-term results of surgery for this condition. Their study not only yields interesting results, but the reader is also made aware of the problems there can be in conducting such a study.Risk factors for developing chronic renal failure in patients with highgrade VUR are described by authors from Rome. All patients were diagnosed in the first year of life, and the mean (range) follow-up was 6.3 (1-16) years. The findings were of interest, although the reader may not be very surprised to hear that they found bilateral high-grade reflux and existing renal damage to be the main predictors of subsequent chronic renal failure.

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Section: Discussionmentioning

confidence: 99%

Coping with bladder exstrophy: diverse results from early attempts at functional urinary tract surgery

Baird¹,

Sanders²,

Woolfenden³

et al. 2004

BJU International

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“…With current surgical techniques children may expect some form of reservoir which will reliably store urine. Since the original achievement of Trendelenberg in 1906 in producing temporary continence and voiding, the results for continence have steadily improved [7]. Continence now is claimed in almost all patients with a staged repair [8].…”

Section: Discussionmentioning

confidence: 99%

The ambitions of adolescents born with exstrophy: a structured survey

2004

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A survey is reported by authors in the UK to determine factors that control the quality of life of adolescent patients with exstrophy; as expected, affected adolescents were resilient characters, and they stressed the importance of patients’ views after surgery to correct this condition.OBJECTIVETo determine the factors that control quality of life as perceived by adolescent patients with bladder exstrophy, and to compare their views using standard instruments.PATIENTS AND METHODSSixteen patients (mean age 19 years, range 16–21, 11 male and five female) were recruited from the departmental database; they represented 46% of those available for the study. After giving informed consent, each had a semi‐structured interview, augmented by completing a self‐reported scale, with the principal investigator. They then completed the Culture‐Free Self‐Esteem Inventory‐2 (CFSEI‐2) and the Brief Symptom Inventory (BSI). The interviews were recorded on audiocassette, transcribed verbatim and evaluated using interpretative phenomenological analysis.RESULTSIn the interviews there was a remarkable consistency in the domains identified as important to the patients. There was a wish to be normal and to be treated as such. This was defined (amongst other items) as being able to void with an appropriate noise, being treated as peers at school and at home, and having an umbilicus. All patients reported some bullying (all but one in the past), but only severely in three. Concerns about self‐image centred on scars and genital appearance. Very similar and effective coping strategies had been created, including practical (e.g. suitable clothes) and emotional (e.g. joking, control of revealed information) aspects. Special arrangements made to help (care by a special assistant or use of a disabled lavatory at school) served only to emphasize their abnormality and were resented. No overt psychiatric or psychological morbidity was detected. There was no difference in scores with the CFSEI‐2 or BSI from established age‐related norms.CONCLUSIONThis study confirms the anecdotally reported strong resilience and personality of adolescents with exstrophy. The domains that patients considered important were not those that their carers might have expected or that are used in standard quality‐of‐life instruments. No morbidity was identified by the two instruments used. In exstrophy, and perhaps in other uncommon conditions, the patients' views of relevant domains should be considered in assessing quality of life.

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“…Among the major causes are chronic recurrent urinary tract infection, interstitial cystitis [1], irradiation sequellae [2], neurogenic bladder dysfunction [3] and bladder exstrophy [4], Surgical management of bladder exstrophy has sub stantially changed in the last 80 years. Early attempts at reconstruction with unsatisfying results [5] subsequently led to primary urinary diversion into the sigmoid colon (ureterosigmoidostomy), which was favored for a long time as the therapy of choice [6].…”

Section: Discussionmentioning

confidence: 99%