title: One - staged reconstruction of bladder exstrophy in male patients: long - term follow-up outcomes.
abstract: BACKGROUND
  The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant.
  
  
  OBJECTIVE
  To present our experience of our modified one-stage reconstruction of bladder exstrophy in male patients.
  
  
  METHODS
  Medical records of male patients submitted to one-stage reconstruction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2±7 years were treated at our institution between 1999-2013.
  
  
  RESULTS
  Eleven patients were referred to us after previous surgery. Sixteen procedures were performed; one patient had complete wound dehiscence and needed another reconstruction (6.7%). Mean follow up was 10.3±4.5 years. No patient has had a loss of renal function. Postoperative complications: four patients (26.6%) presented small fistulas, one presented penile rotation. Eleven patients (73.3%) patients underwent bladder-neck surgery. Five (33.3%) required bladder augmentation. Three cases (20%) needed subsequent treatment of VUR. At the time of our review nine (60%) patients achieved UC, two (13.3 %) patient without additional procedure. A mean of 3±1.1 procedures (2-5) was accomplished per children.
  
  
  CONCLUSIONS
  One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies.
authors.affiliation: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors.forename: Amilcar Martins
authors.initials: AM
authors.lastname: Giron
authors.affiliation: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors.forename: Marcos Figueiredo
authors.initials: MF
authors.lastname: Mello
authors.affiliation: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors.forename: Paulo Afonso
authors.initials: PA
authors.lastname: Carvalho
authors.affiliation: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors.forename: Paulo Renato Marcelo
authors.initials: PR
authors.lastname: Moscardi
authors.affiliation: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors.forename: Roberto Iglesias
authors.initials: RI
authors.lastname: Lopes
authors.affiliation: Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D055815:Young Adult
keywords: Bladder Exstrophy; Patients; Reconstructive Surgical Procedures