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S26-13
(P)
RADICAL SOFT TISSUE MOBILISATION AND EXTENSIVE TOTAL PENILE
CORPORAL DISSECTION FOR THE REPAIREMENT OF THE BLADDER EXTROPHY
AND EPISPADIAS
Haluk EMIR
1
, Mehmet ELIÇEVIK
1
, Senol EMRE
1
, Rahsan ÖZCAN
1
, Agil ABILOV
2
, Latif ABBASOGLU
3
, Selim AKSÖYEK
4
,
Osman Faruk SENYÜZ
5
, Cenk BÜYÜKÜNAL
1
and Yunus SÖYLET
1
1) Istanbul University, Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Division of Pediatric Urology,
Istanbul, TURKEY - 2) Memorial Healthcare Group, Hizmet Hospital, Pediatric Surgery, Istanbul, TURKEY - 3) Acibadem
University Medical Faculty, Bakirkoy Hospital, Pediatric Surgery, Istanbul, TURKEY - 4) Medicana International, Istanbul
Hospital, Pediatric Surgery, Istanbul, TURKEY - 5) Istanbul University, Cerrahpasa Medical Faculty, Department of
Pediatric Surgery, Istanbul, TURKEY
PURPOSE
To evaluate early postoperative period after radical soft tissue mobization(RSTM) and total penile corporal dissection for
bladder exstrophy epispadias complex(EEC).
MATERIAL AND METHODS
The medical records of EEC patients who were operated between 2010-2015 were analyzed, retrospectively. The
operative technique consisted of the RTSM, bilateral extensive penile corporal dissection from the pubic arms and a
tension free bladder neck recontruction as in Kelly procedure. Excision of excessive polyps and dorsal detrusorotomy if
the bladder is too small. Urethroplasty and epispadias repair If the urtehral plate is healty and long enough, creation of
penoscrotal hypospadias and epispadias repair, if not. Genital reconstruction with the use of anatomical repositioning of
the vagina including clitoral and corporal plasty over the neourethra in girls.
RESULTS
The technique was performed in 62 patients(F:15,M:47), mean age of was 58(r:4-336) months. The preoperative status
was primary EEC in 20pts., EEC with closed bladder in 15pts., repaired EEC with total urinary incontinence in
7pts.(epispadias:1,EEC:6), failed EEC repairs in 14pts.(epispadias:3, EEC:11), epispadias in 6pts. Early surgical
complications were catheter dislodgement(n: 4), bladder neck fistula(n:2), urethrocutaneous fistula(n:1), skin
dehiscence(n:2), fascial dehiscence(n:2), perirenal urinoma(n:1), urosepsis(n:2), urethral stricture(n:1).The patients
developed neither corporal-glandular tissue loss nor ischemia. Bladder neck fistulas disappered after local care.
Transurethral voiding was established in 45 patients. CIC was started in 17 patents.
CONCLUSIONS
RSTM and extensive penile corporal release from the pubic arms allow a tension free urogenital reconstruction in EEC
with an acceptable complication rate. Even small bladders can be succesfully closed using RTSM, excision of the polipoid
mucosal tissue and dorsal detrusorotmy. This surgical approach might decrease the need of augmentation procedures in
this group of patenti. Changes in the upper urinary tract and urinary continence should be closely followed up.