2005, Number 2
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Rev Mex Urol 2005; 65 (2)
Previous or innominated osteotomy, for osseous, urinary and genital reconstruction in vesical exstrophy
Espinosa CGB, Rodríguez GR
Language: Spanish
References: 15
Page: 118-123
PDF size: 92.24 Kb.
ABSTRACT
We reported our clinical experience of the utility of vesical previous iliac osteotomy in cases of vesical exstrophy and their variants, for anatomic, genital urinary and osseous reconstruction. We have made in 35 patients previous iliac osteotomy for closing pelvic ring and medial migration of the structures of the abdominal muscular wall and urogenital diaphragm and external genitals. The osteotomy was made by the group of Pediatric Orthopedics in a first surgical time, and the urinary, genital and abdominal reconstruction in second time by Pediatric Urology. This series includes 19 boys and 16 girls with vesical exstrophy classic and some clinical variations, including 10 cases of cloacal exstrophy; the interpubic distance varied from 6 to 12 cm; four patients with previous later classic osteotomy and 30 patients with insolvent attempt of vesical closing were included, nonsuccessful with exstrophy reproduction. As method of external fixation we used metallic nails of Shanz and tubular tensions type AO by space of eight weeks. The urinary reconstruction included plastia of vesical neck Young-Dees-Leadbetter type, cistoplasty of increase with gastric segment, in addition to elongation of cavernous bodies and uretra plasty. The closing of the pelvic ring allowed the anatomical reconstruction of the abdomen, urinary and genital system almost to normality due to the wide mobilization of the pelvic and muscular ring with the osteotomy, six patients developed total urinary continence. There was no exstrophic reproduction, in these cases. Previous iliac osteotomy is a useful and reliable alternative for urinary, genital and osseous reconstruction in cases of vesical exstrophy.
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