Cloacal exstrophy: a complex disease.
BACKGROUND
Cloacal exstrophy is a rare occurrence with an incidence of 1:200,000 to 1:400,000 live births. It represents one of the most challenging reconstructive endeavors faced by pediatric surgeons and urologists. Aside from the genitourinary defects, there are other associated anomalies of the gastrointestinal, musculoskeletal and neurological systems that require a multidisciplinary approach when counseling anxious parents.


METHODS
We present a video of a patient with cloacal exstrophy treated with 21 days of life. Surgery consisted of separation and tubularization of the cecal plate from the exstrophied bladder halves and colostomy construction. The bladder was closed primarily and umbilical scar reconstructed and used for ureteral and cistostomy drainage. A urethral catheter was used to guide bladder neck tubularization. A final epispadic penis was obtained and planned for further repair in a second step.


RESULTS
The patient had an initial uneventful postoperative course and immediate outcome was excellent. The bladder healed nicely but patient presented with abdominal distension in the 5th day of postoperative setting requiring parenteral nutrition. The distal colon persisted with lower diameter although non obstructive, but causing difficulty for fecal progression. Continuous colostomy dilatation and irrigation were required.


CONCLUSIONS
Approximating the bladder halves in the midline at birth and primary bladder closure is a viable option, intestinal transit may be a issue of concern in the early postoperative follow-up.
Division of Urology, Universidade Federal de Sao Paulo, São Paulo, Brazil.
Antonio
A
Macedo
Atila
A
Rondon
Ricardo
R
Frank
Herick
H
Bacelar
Bruno
B
Leslie
Sergio
S
Ottoni
Gilmar
G
Garrone
Riberto
R
Liguori
Valdemar
V
Ortiz
D001746:Bladder Exstrophy / Q000601:surgery*; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D003125:Colostomy; D006801:Humans; D007231:Infant, Newborn; D007422:Intestines / Q000002:abnormalities* / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome