[Surgical treatment of the extrophy-epispadias complex. Review and current concepts].
Since earlier descriptions the surgical management of the bladder exstrophy and epispadias complex (BEEC) has experimented gradual changes in the search for good aesthetic and functional results. The initial urinary diversion and bladder plate removal has evolved under various authors either by improving or supplementing the above described advances, until reaching the staged functional closure and more recently the complete primary BEEC closure. These later techniques allow to obtain encouraging continence indexes and successful aesthetic results; the low incidence and complexity of this condition however, advises both in terms of early management and later complications that this should be managed in reference centres. Sharing on this spirit of technique combination in search for a satisfactory result for exstrophic newborns and inspired by Leadbetter's contribution to Young-Dees's procedure for vesicoureteral reflux (VUR) correction, we have added a new step to the complete primary BEEC closure known as the Mitchell's technique by performing Gil-Vernet's trigonoplasty to prevent VUR, closely associated to bladder exstrophy. We believe VUR can be prevented right from the first surgical approach in the exstrophic newborn.
de la Peña
E
E
Unidad de Urología Pediátrica, Servicio de Urología, Fundació Puigvert, Barcelona.
Hidalgo
J
J
Caffaratti
J
J
Garat
J M
JM
Villavicencio
H
H
D000015:Abnormalities, Multiple / Q000601:surgery*; D001746:Bladder Exstrophy / Q000601:surgery*; D004842:Epispadias / Q000601:surgery*; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011630:Pubic Bone / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000517:prevention & control