Radical soft tissue mobilization and reconstruction (Kelly procedure) for bladder extrophy [correction of exstrophy] repair in males: initial experience with nine cases.
OBJECTIVE
to report the early experience with the Kelly procedure for the treatment of bladder exstrophy (BE) in males.


METHODS
Nine boys with BE were treated at our institute. One had an untouched BE, four had epispadias after neonatal bladder closure, and four were secondary phalloplasties. Data on surgical complications, continence status, presence of erections and parental satisfaction with penile appearance and length are reported.


RESULTS
Mean patient age was 4.7 (1-8.9) years. No intra-operative complications occurred. Two secondary cases experienced formation of a bladder-neck fistula and glans ischemia, respectively. The latter led to glans loss. All the patients had some residual degree of hypospadias after surgery. After a median follow-up of 18.1 (10-22) months, one patient developed chronic bladder outlet obstruction. Overall, five patients are dry (including two on clear intermittent catheterization and one with a Minz II pouch). The other four are still younger than 3 years, all have spontaneous micturitions and dry interval between 30 and 120 min. Of the eight patients without phalloplasty complications, all had erections, and parents judged the penile length and appearance as being satisfactory in six cases.


CONCLUSIONS
The Kelly procedure is feasible in a vast array of BE patients, but may be formidable, especially in secondary phalloplasties. It allows for complete reconfiguration and lightening of the penis, but exposes to potentially catastrophic complications, such as partial or complete penile loss. Longer follow-up is needed to assess the results in terms of continence.
Berrettini
Alfredo
A
Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Monoblocco Ospedaliero, Via Giustiniani, 2, 35100, Padua, Italy.
Castagnetti
Marco
M
Rigamonti
Waifro
W