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Female Genito‐urethroplasty and Submucosal Periurethral Collagen Injection as Adjunctive Procedures for Continence in the Exstrophy‐epispadias Complex Preliminary Results
Author(s) -
CAIONE P.,
CAPOZZA NICOLA,
LAIS A.,
CRETI G.,
GENNARO M.
Publication year - 1993
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1993.tb15957.x
Subject(s) - epispadias , urethroplasty , bladder exstrophy , medicine , neck of urinary bladder , urinary continence , urethra , urology , surgery , urinary diversion , urinary bladder , cystectomy , prostate , prostatectomy , bladder cancer , cancer
Summary— Continence is the main goal in the treatment of patients with bladder exstrophy and prognosis is necessarily long‐term. Over an 8‐year period, 44 patients presented with bladder exstrophy and/or incontinent epispadias. Twenty‐five bladder closures (7 secondary), 23 male urethroplasties, 19 bladder neck (BN) reconstructions and 6 bladder augmentations were performed in these patients. In 18 children 2 additional procedures were employed in the last 3 years: female genito‐urethroplasty (15) and submucosal periurethral collagen injection (11). Eight children underwent both procedures. Genito‐urethroplasty and collagen injection were performed before BN reconstruction in 6 and 5 cases respectively, in order to increase bladder outlet resistance. The submucosal injection was performed at 3, 9 and 12 o'clock in the BN or sphincteric urethra, using 0.75 to 2.5 ml of cross‐linked bovine collagen. Continence in the children who underwent the complete staged reconstruction was good in 58%, fair in 32% and poor in 11%. Following female genito‐urethroplasty and periurethral collagen injection, bladder capacities increased by 25%. These complementary procedures are effective in increasing outlet resistance and bladder capacity in patients with exstrophy and/or epispadias; they may improve continence and lessen the need for further bladder augmentation.