title: Management of bladder exstrophy epispadias complex in adults: is abdominal closure possible without osteotomy?
abstract: OBJECTIVE
  Presentation of bladder exstrophy epispadias complex (BEEC) during adulthood is rare. A major surgical challenge encountered in adults with BEEC is the closure of the anterior abdominal wall defect. In this case series we report our experience with the abdominal closure without osteotomy.
  
  
  METHODS
  Five adult male patients with BEEC were managed at our center. None of the patients had any prior attempts of surgical correction. A right renal tumor was incidentally discovered in one patient and a right partial nephrectomy was performed. All patients underwent urinary diversion and abdominal wall closure at the same operative setting except one. Cystectomy was performed in two patients while the vesical plate muscular coat was utilized for providing support to the anterior abdominal wall in the other three patients. One patient underwent an ileal conduit, while the other patients underwent continent cutaneous diversion. None of our patients underwent osteotomy.
  
  
  RESULTS
  Follow-up ranged from 6 to 52 months (mean = 31). Patients who underwent continent cutaneous diversion were continent by day and night. One patient had wound infection and partial disruption and secondary sutures were performed. One patient developed stomal stenosis and was managed by stomal dilatation. All patients showed marked satisfaction with their body image following surgery.
  
  
  CONCLUSIONS
  Management of BEEC in adults is challenging. Utilization of the vesical plate muscular coat for supporting the anterior abdominal wall is a reliable method for abdominal reconstruction. Urinary diversion and abdominal wall closure in one surgical procedure without osteotomy is feasible.
authors.affiliation: Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Mansour
authors.forename: Osama M
authors.initials: OM
authors.lastname: Sarhan
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.forename: Bassam
authors.initials: B
authors.lastname: Awad
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Dawaba
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Ghali
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D001746:Bladder Exstrophy / Q000601:surgery*; D004842:Epispadias / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D017060:Patient Satisfaction; D010384:Pelvic Bones; D011183:Postoperative Complications / Q000517:prevention & control; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014547:Urinary Diversion / Q000379:methods*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult