Profile of children presenting with Exstrophy Bladder to Christian Medical Collage, Vellore, between the years 1991 to 2009, their management and follow up – A Descriptive study.

Ravi, Kishore (2010) Profile of children presenting with Exstrophy Bladder to Christian Medical Collage, Vellore, between the years 1991 to 2009, their management and follow up – A Descriptive study. Masters thesis, Christian Medical College, Vellore.

[img]
Preview
Text
180501110ravikishore.pdf

Download (3MB) | Preview

Abstract

BACKGROUND : Exstrophy Epispadias complex is a midline abdominal anomaly characterized by defects involving the urinary system, the musculoskeletal system, the pelvis, the pelvic floor, the abdominal wall, the genitalia and sometimes the spine and the anus. Reconstruction involves closure of the defects, various methods of which have been devised over the years. Important factors determining the success of closure are achievement of continence with a good low pressure urinary reservoir for preservation of the upper renal tracts. MATERIALS AND METHODS : A total of 102 children with Exstrophy epispadias and incontinent epispadias presenting between 1991 and 2009 were studied. Exstrophy: 50 were fresh cases and 42 operated elsewhere. Incontinent epispadias: 5 were fresh cases and 1 was operated elsewhere. Various methods of primary closure were reviewed. Complications following closure, namely failure of closure, incontinence, upper renal tract changes, altered bladder compliance etc., were listed and their management was reviewed which included bladder neck procedures and Agmentation cystoplasty. Patients were then followed up with regard to above mentioned factors. RESULTS : Closure was achieved in all the followed up patients: Out of 50 New cases, 45 achieved closure following primary closure at first instance. Of the 22 failed closures ( 17 operated elsewhere + 5 failed among new cases), closure was achieved in all, subsequently, with or without concomitant augmentation. Continence was achieved with primary closure and bladder neck procedure in 18 of the 81 followed up children, bladder augmentation was required in 37. Another 8 advised augmentation. 12 of the 48 with ultrasound follow-up developed hydro-ureteronephrosis which resolved or decreased after augmentation in 8. Vesico-ureteric reflux was seen in 30 (50 refluxing units) of the 31 patients with MCU follow-up. With Augmentation +/- reimplantation, reflux resolved or decreased in 21 of the 28 units further followed up with MCU. CONCLUSIONS : In our scenario of delayed presentation to a tertiary care centre, where the pliability of the bony pelvis, crucial for Exstrophy repair, is lost. Hence, Rectus muscle flap without pubic bone approximation has been developed for successful closure, even in repeatedly failed closures. Continence rate has been low, again for the same reason, with most requiring an augmentation cystoplasty. Those closed successfully need to be followed up for Upper tract changes with Urodynamic study in addition to ultrasound and MCU imaging, since a closed bladder is a potential high pressure system, and needs to be treated if so.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Exstrophy Bladder ; Profile of children ; management and follow up ; A Descriptive study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 01 Aug 2017 03:15
Last Modified: 01 Aug 2017 08:23
URI: http://repository-tnmgrmu.ac.in/id/eprint/2406

Actions (login required)

View Item View Item