Snc. Buyukunal, INTERIM-REPORT IN HUMANS OF A PREVIOUSLY DESCRIBED TECHNIQUE IN AN ANIMAL-MODEL - CLOSURE OF BLADDER EXSTROPHY WITH RECTUS-ABDOMINIS MUSCLEFLAP-II, The Journal of urology, 152(2), 1994, pp. 706-709
The results of a new bladder closure and augmentation technique in chi
ldren born with bladder exstrophy are reported. The technique was perf
ormed in 6 children, including 4 who had, in addition to a small, inel
astic, noncompliant bladder, squamous epithelial metaplasia and polypo
id transformation. In the remaining 2 patients this technique was used
after failed primary closures. A full thickness left rectus abdominis
island flap containing skin, fascia, muscle and peritoneal layers is
prepared with an intact neurovascular pedicle from the inferior epigas
tric artery. This flap is rotated to cover the bladder defect and aid
in augmentation. The inner layer formed by peritoneum is sutured to th
e edges of the bladder defect. Postoperative endoscopic and histopatho
logical investigations revealed the inner peritoneal layer of the flap
to be completely covered by transitional bladder epithelium. No major
surgical complications occurred in these 6 cases. Considering the adv
antages of the technique from this limited experience, evidence sugges
ts that there is no need for a major gastrointestinal operation for bl
adder augmentation, since an acceptable bladder capacity was available
. There was no mucus production from the inner layer of the flap, and
metabolic and electrolyte disturbances were reduced.