Total urogenital complex mobilization in female patients with exstrophy

Purpose: Female bladder exstrophy/epispadias has traditionally been approac hed in a staged fashion. This approach results in a vagina that remains in an abnormal position on the anterior abdominal wall. We present a surgical correction of the female exstrophy/epispadias urogenital complex with total mobilization that returns the vagina to its proper anatomical position. Materials and Methods: Since 1997, 7 female patients presenting with varian ts of the exstrophy/epispadias complex have undergone surgical repair using total urogenital complex mobilization. Of the patients 1 newborn and 2 sch oolage children had classic bladder exstrophy, 2 schoolage children had clo acal exstrophy and 2 schoolage children had primary epispadias. Total uroge nital complex mobilization involved treatment of the urethra and vagina as a single unit. Complete disassembly of the pelvic diaphragm or floor anteri or to the rectum was required to reposition the urethra and vagina to their proper anatomical positions in the perineum. The pelvic diaphragm was then reconstructed anterior to the urogenital complex to recapitulate the norma l female pelvic floor anatomy. Results: All patients have an anatomically correct position of the urogenit al complex. All the vaginas reached the perineum without the need for skin flaps. All patients have adequate vaginal caliber without evidence of steno sis. Conclusions: The female with exstrophy/epispadias has unique anatomical def ects in the urogenital complex that require special attention. Anterior dis placement of the bladder, urethra and vagina with concomitant lack of devel opment of the anterior pelvic floor musculature make a single stage, total urogenital complex mobilization repair ideal for this population. The resul ts of this technique have been functionally and cosmetically pleasing. Whet her repositioning the urogenital complex into the normal anatomical positio n will improve bladder dysfunction and urinary continence rates, and decrea se or eliminate the need for future surgery will only be known after furthe r long-term followup has been completed.