Grady R W, Mitchell M E
Department of Urology, Children's Hospital and Regional Medical Center, Seattle, Washington, USA.
J Urol. 1999 Oct;162(4):1415-20.
The surgical correction of bladder exstrophy to achieve continence with voiding remains a challenging problem for the urologist. Since 1989 we have performed complete primary repair for exstrophy based on the concept that the primary defect of bladder and cloacal exstrophy is anterior herniation. Thus, the bladder and urethra must be treated as a single unit to move them posteriorly into the pelvis. We present this technique.
From 1989 to 1997, 18 patients with bladder exstrophy and 6 with cloacal exstrophy underwent complete primary repair of exstrophy. This procedure was done on day 1 of life in 18 patients. Mean followup is 44 months (range 4 months to 8 years).
At a median followup of 48 months 4 boys and 4 girls have volitional voiding after complete primary repair of bladder exstrophy, 21 patients have continent intervals and 2 boys void with continent intervals after complete primary repair of cloacal exstrophy. No patient has had a loss of renal function in this series. Postoperative complications included urethrocutaneous fistula formation in 2 cases. No patient had primary closure dehiscence.
The rate of urinary continence achieved with complete primary repair compares favorably to that of staged repair for exstrophy. Complete primary repair also minimizes the number of surgical procedures required to achieve urinary continence and potentiates bladder neck function that permits bladder cycling in year 1 of life. The complication rates of these techniques are significantly lower than those reported in previous series of primary closure of exstrophy.
膀胱外翻的外科矫正以实现可控排尿对泌尿外科医生来说仍然是一个具有挑战性的问题。自1989年以来，我们基于膀胱和泄殖腔外翻的主要缺陷是前腹壁疝这一概念，对外翻进行了完全一期修复。因此，必须将膀胱和尿道视为一个整体，将它们向后移入骨盆。我们介绍这项技术。
1989年至1997年，18例膀胱外翻患者和6例泄殖腔外翻患者接受了外翻的完全一期修复。18例患者在出生第1天进行了该手术。平均随访时间为44个月（范围4个月至8年）。
膀胱外翻完全一期修复术后，中位随访48个月时，4名男孩和4名女孩能自主排尿，21例患者有可控排尿间期，泄殖腔外翻完全一期修复术后，2名男孩有可控排尿间期。本系列中无患者出现肾功能丧失。术后并发症包括2例尿道皮肤瘘形成。无患者出现一期缝合裂开。
完全一期修复实现尿失禁的比率与分期修复外翻的比率相比具有优势。完全一期修复还将实现尿失禁所需的手术次数减至最少，并增强膀胱颈功能，使患儿在1岁时能够进行膀胱循环。这些技术的并发症发生率明显低于先前一系列外翻一期缝合报道的发生率。
