title: Use of muscle pedicle flaps for failed bladder neck closure in the exstrophy spectrum.
abstract: OBJECTIVE
  The authors have reviewed the use of muscle pedicle flaps for the treatment of failed bladder neck closure in exstrophy spectrum patients.
  
  
  METHODS
  A retrospective review of all exstrophy spectrum patients who underwent continence procedures with the use of muscle pedicle flaps at our institution during the last 15 years was performed. Patient characteristics, surgical history, and outcomes, including complications, continence, morbidity, and infection, were assessed. The authors utilized muscle pedicle flaps in eight exstrophy patients, including four patients with classic bladder exstrophy and four patients with cloacal exstrophy. Seven of eight patients had failed at least one prior bladder neck closure, and they had undergone a median of three prior urologic procedures. To achieve continence, five rectus muscle flaps and three gracilis muscle flaps were utilized in combination with bladder neck closure.
  
  
  RESULTS
  There were no major intraoperative or postoperative complications. All patients were initially continent, and after a median follow-up of 18.7 months seven of eight patients were continent. One patient required continent urinary stoma revision and one patient developed perineal incontinence after perineal trauma. No patients required revision of, or additional, continence procedures at the bladder neck.
  
  
  CONCLUSIONS
  The use of pedicle muscle flaps appears to be a safe and feasible option for exstrophy spectrum patients with failed bladder neck closure. Although achieving continence can be difficult in this population, use of muscle flaps and bladder neck closure is a viable and effective option in this challenging subset of patients.
authors.affiliation: Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA. Electronic address: jmichau4@jhmi.edu.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Michaud
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ko
authors.affiliation: Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lue
authors.affiliation: Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Di Carlo
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
authors.affiliation: Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D006801:Humans; D008297:Male; D017568:Rectus Abdominis / Q000637:transplantation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Bladder exstrophy; Urinary diversion; Urinary incontinence; Urologic surgical procedures