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VR-41
(VS)
NEONATAL CLOSURE OF BLADDER EXSTROPHY
Pankaj MISHRA, Simon RAJENDRAN and Imran MUSHTAQ
GREAT ORMOND STREET HOSPITAL, PAEDIATRIC UROLOGY, London, UNITED KINGDOM
PURPOSE
Bladder exstrophy is a rare congenital malformation involving the lower abdominal wall, the pelvic structures and the
urogenital system. The primary aim in management is to close the open bladder in order to facilitate its growth and
function.
MATERIAL AND METHODS
This video aims to demonstrate the bladder closure for classic bladder exstrophy.
The ureteric orifices are identified and stented. Large mucosal polyps are excised and mucosa repaired. A midline
incision is made starting above the umbilical cord, encircling it and extending on each side on the mucosal edge of the
bladder up to the level of the verumontanum. The edge of bladder is partially mobilised and bladder closure is started
from dome with interrupted inverting sutures. A stent is placed across the bladder neck and secured before the closure
of the bladder.
The abdominal muscles are mobilised off the skin and apposed with interrupted horizontal mattress sutures starting
from the upper part of the wound. In the lower part of the wound the sutures are applied and put on cross-over traction
to stretch the pelvic ligaments, and tied in turn while maintain the traction to approximate the pelvis. The skin and
subcutaneous tissue are approximated.
Epidural analgesia and enteral nutrition is the key to postoperative pain management and healing.
RESULTS
Neonatal bladder closure restores the near normal anatomy, facilitates growth and function of the bladder and allows for
early bonding of the baby.
CONCLUSIONS
This video demonstrates neonatal closure of bladder exstrophy.