Kouame Bertin Dibi, Kouame Guy Serge Yapo, Sounkere Moufidath, Koffi Maxime, Yaokreh Jean Baptiste, Odehouri-Koudou Thierry, Tembely Samba, Dieth Gaudens Atafi, Ouattara Ossenou, Dick Rufin
Department of General pediatric Surgery, Teaching Hospital of Yopougon, Abidjan BP 632, Cote d'Ivoire.
Afr J Paediatr Surg. 2015 Jan-Mar;12(1):56-60. doi: 10.4103/0189-6725.150985.
Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes.
We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis.
Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof.
When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length.
术后并发症与手术操作、初次膀胱关闭失败有关，并影响泌尿外科、美学和骨科治疗效果。
我们回顾了14年间接受复杂膀胱外翻-尿道上裂修复术的4例患者。采用美学、泌尿外科和骨科检查数据评估治疗效果。通过骨盆X线检查探讨骨科并发症。
在接受膀胱外翻手术治疗的4例患者中，3例在短期和长期随访中获得了美学、功能效果及并发症方面的良好结果。首例患者为男性，阴茎外观良好。排尿时勃起正常，尿流良好。他有中度尿失禁，需要使用尿布。勃起时，他的阴茎长4厘米，周长3厘米。第二例患者为女性。她的女性外生殖器外观不佳，阴蒂二分。无法评估尿失禁情况；她尚未达到能自主保持清洁的年龄。第三例患者因尿道上裂修复失败出现大量尿漏。他有跛行、骨盆倾斜度、股骨头内翻和内旋。他存在肢体长度不等。骨盆X线片显示右侧通过髂骨截骨，左侧通过髋臼顶髋关节截骨。
当尿道上裂修复术与初次膀胱关闭同时进行时，其成功与否对尿失禁起决定性作用。对于女性患者，初次膀胱关闭后需要进行手术矫正以改善外生殖器的美观。必须在手术放大镜辅助下进行无名骨截骨，避免截骨穿透髋关节，以防止腿长不等。
