RECTUS-ABDOMINIS MUSCLE FLAP (RAMF) TECHNIQUE FOR THE MANAGEMENT OF BLADDER EXSTROPHIES - LATE CLINICAL OUTCOME AND URODYNAMIC FINDINGS

Objective To investigate the efficacy of the rectus abdominis muscle n ap (RAMF) technique for the closure and augmentation of small, non-com pliant bladder extrophies. Patients and methods The RAMF technique was used in two girls and two boys (mean age at operation, 31.7 months, r ange 3-72) with bladder exstrophy. The clinical outcome and urodynamic s were assessed during a follow-up of 29 months to 6 years (mean 49.2 months) and included imaging, cystoscopy, biochemical and microbiologi cal studies. Results There were no urinary tract infections, metabolic problems or electrolyte disturbances and kidney function remained nor mal in all patients, Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the i nner peritoneal layer of RAMF with uroepithelium. No stone formation o r mucus production were detected. Currently, three patients void using clean intermittent catheterization through the native urethra and the fourth through an appendiceal Mitrofanoff valve, However, the bladder volume was insufficient at the late follow-up and three patients requ ired bladder augmentation. Conclusions The RAMF technique is a good al ternative for closing bladder extrophies and achieves an increase in b ladder capacity; however, although there is a mild improvement in blad der capacity and compliance, RAMF should not be used as a bladder augm entation procedure, The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compl iant bladder remnants and failed primary closures.