COMPLICATIONS OF PARAEXSTROPHY SKIN FLAPS IN THE RECONSTRUCTION OF CLASSICAL BLADDER EXSTROPHY

We reviewed the cases of the exstrophy/epispadias complex treated at o ur institution between July 1976 and April 1992. A total of 78 patient s was identified who had paraexstrophy skin flaps used in the bladder closure, of whom 31 (40%) had a complication as a result of the flaps. The main complication encountered was a urethral stricture where the paraexstrophy skin flaps joined the urethral plate area. Multiple mane uvers were undertaken to correct these problems, including direct visi on internal urethrotomy (12 cases), multiple urethral dilations (4), o pen revision (3) and full thickness skin grafts (5). Seven patients ha d such a complex stricture situation that they required either contine nt urinary diversion (5), colon conduit diversion (1) or cutaneous ure terostomy (1), the latter 2 patients having undergone vesicostomy else where before referral. Of the remaining 24 patients who did not underg o a diversionary procedure 12 have undergone an epispadias repair and bladder neck reconstruction, 7 underwent an epispadias repair and 5 aw ait further treatment. Freedom from complications in the initial closu re of exstrophy significantly improves the chances of successful recon struction. The avoidance of problems leading to obstruction, infection , hydronephrosis and reflux nephropathy will provide better kidneys re gardless of bladder suitability for function or augmentation. Our use of paraexstrophy flaps has decreased but when they are required, speci al care in design, placement and followup is advised to avoid complica ting strictures and their sequelae.