Closure of bladder in the extrophy epispadisis complex by rectus muscle flap without pelvic osteotomy, a new approch

Introduction: Bladder Exstrophy (BE) is a congenital anomaly in which the bladder and abdominal wall and external genitalia are pathologically open. Incidence of this anomaly is one in 50000. Treatment of this anomaly is complicated and, the old method of treatment was pelvic osteotomy. The aim of this study was offering a new surgical approach, which is closure of the bladder in bladder exstrophy-epispadiasis complex using rectus muscle flap without pelvic osteotomy. Methods: From Nov 2008 to Nov 2011 15 cases of BE containing 10 boys (70%) and 5 girls (30%) were under 3 steps of surgical operation. Patients were followed up in this period and outcomes and complications of this new surgical approach were recorded. Results: Mean volume of bladder after first operation was 58.2±3.71 milliliter (ml). There were 4 cases of wound infection (26.6%), 3 wound dehiscence (20%) and 2 bladder dehiscence (13.3%). After the second step of surgery there were 3 cases of wound infections (20%), 4 cases of uretero-vesical fistulas (26.6%). After third step of surgery there were 2 cases of wound infections (13.3%) and 4 cases of bladder dehiscence's (26.6%). The shape and size of external genitalia in 6o% of boys and in 80% of girls were acceptable. The mean time of the urinary continency was 25 min. Conclusion: Outcomes of the new surgical technique, based on our study, were acceptable and complications with little and controllable complications. Sُo we recommend the new surgical technique for bladder exstrophy repair.