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(VS)
BLADDER NECK RECONSTRUCTION FOR INCONTINENT EPISPADIAS: MITCHELL
TECHNIQUE WITH DETRUSOR MUSCLE WRAP
Salah NAGLAA
1
, Haytham BADAWY
2
, Waleed DAWOOD
2
, Amr ZOAIER
2
, Ahmed ABULFOTOOH EID
2
, Hany ABDELHAMID
3
and Samir SHAABAN
2
1) Faculty of medicine, university of tanta, Department of urology, Tanta, EGYPT - 2) Faculty of medicine, university of
alexandria, Department of urology, Alexandria, EGYPT - 3) Students insurance hospital, Department of urology,
Alexandria, EGYPT
PURPOSE
Incontinent penopubic epispadias in male children needs bladder neck reconstruction for achievement of urinary control.
Many techniques are in current use including the Mitchell with or without detrusor wrap technique.
MATERIAL AND METHODS
Five children with isolated epispadias, 3 boys and 2 girls were operated in the last 5 years by the same surgeon ( H
BADAWY), median age at surgery was 4,5 y (3,5-5), 4 operated without a bladder wall wrap and only one patient with a
bladder wrap. The video describes male patient 5 year old operated by total disassembly for correction of penopubic
epispadias. Voiding cystogram, ultrasound abdomen and pelvis, Cystometry all showed normal bladder capacity for age
with low sphincteric resistance. Midline suprapubic incision with intersymphyseal approach was used. Tubularization of
the urethra over 10 Fr catheter leaving at the end 8fr catheter was performed by interrupted 5/0 vicryl sutures. Bladder
wall flap 2cm x 6 cm demucosalized and wrapped around the reconstructed bladder neck and urethra. Urethral catheter
was left for 5 days, ureteric catheters, suprapubic catheter for 2 weeks clamped and left inside to ensure no retention
then removed.
RESULTS
four children attained complete continence for more than 4 hours diurnal and occasional nocturnal enuresis in 2 female
children, one male child is dry for one hour only diurnal with nocturnal enuresis.
CONCLUSIONS
The technique is easy, feasible, and reproducible however, the results need longer follow up and larger number of
children.