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THE STEP-BY-STEP TECHNIQUE OF RADICAL SOFT TISSUE MOBILISATION
(KELLY PROCEDURE) IN MALE BLADDER EXSTROPHY
Marc-David LECLAIR, Thierry VILLEMAGNE, Sébastien FARAJ and Etienne SUPLY
Children University Hospital, Pediatric Surgery, Nantes, FRANCE
PURPOSE
The Radical-Soft Tissue Mobilization (RTSM, Kelly procedure), has been described as an alternative to staged
reconstruction and to Complete primary repair in bladder exstrophy and incontinent epispadias.
We aimed to demonstrate and illustrate the different steps of this technique.
MATERIAL AND METHODS
A 12 month-old boy, with classic bladder exstrophy, underwent bladder closure without osteotomy at birth. Bladder
assessment at 12 months showed small 30mL bladder, early bilateral VUR, and uncorrected proximal epispadias.
A RSTM mobilization is perfomed, as described by KELLY-JH. Pediatr Surg Int 1995;10:298-304 :
- dissection of the bladder and internal pelvic ring
- incision of the internal obturator fascia, and division of the levator anii fibers
- ventral dissection of the penis
- detachment of the corpora from the ischio-pubic branches, in a superiosteal plan
- dissection of the puddendal pedicle, at the exit of the Alcock's canal
- dissection of the urethral plate from the corpora cavernosa
Reconstruction :
- ureteric reimplantation
- urethrocervicoplasty
- urethral transposition in hypospadias
- re-approximation of mobilized structures around the bladder-neck and the neo-urethra
- corpora derotation and attachment to the neo-symphisis
- penile skin reconstruction
The video recording is shown in a step-by-step editing, with drawings.
An abdominal CT-scan with angiogram, performed at day 10 postoperatively for another reason, allowed to perform 3D-
Volume rendering reconstruction of the corpora cavernosa, showing their anerior translation.
CONCLUSION
The Kelly procedure is a reproducible technique of urethro-cervicoplasty in patients with bladder exstrophy or
incontinent epispadias, potentially providing active infra-cervical resistances, and optimizing penile length for epispadias
reconstruction