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Rudin AY, Rudin YE, Sokolov YY. Anatomical features of the malformation, methods and results of bladder exstrophy primary closure. Literature review. Androl genit hir 2023. [DOI: 10.17650/2070-9781-2022-23-4-55-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- A. Yu. Rudin
- Children’s City Clinical Hospital of St. Vladimir of the Moscow Healthcare Department
| | - Yu. E. Rudin
- Children’s City Clinical Hospital of St. Vladimir of the Moscow Healthcare Department; N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia
| | - Yu. Yu. Sokolov
- Children’s City Clinical Hospital of St. Vladimir of the Moscow Healthcare Department; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia
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Taher H, Elboraie A, Fares A, Tawfiq S, Elbarbary M, Abdullateef KS. Laparoscopic inguinal hernia repair in bladder exstrophy, a new modified solution to an old problem: A cohort study. Int J Surg Case Rep 2022; 95:107252. [PMID: 35636219 PMCID: PMC9157442 DOI: 10.1016/j.ijscr.2022.107252] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/08/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Open inguinal hernia repair in children with bladder exstrophy is challenging and associated with a high recurrence rate (15%-22%). We report our initial experience with laparoscopic repair of inguinal hernias in five children with repaired bladder exstrophy. This study is the third describing inguinal hernia repair in bladder exstrophy patients using the laparoscopic approach. In this study, we report a different laparoscopic technique. METHODS This retrospective study was performed on data regarding laparoscopic inguinal hernia repair collected over one year (July 2019-2020). We carried out the laparoscopic inguinal hernia repair, closing the internal inguinal ring using a non-resorbable sliding knot suture and incorporating the transversalis fascia for reinforcement, followed by purse-string closure of the peritoneum. Peri- and postoperative outcome parameters, including recurrence rate, were evaluated over a follow-up period of 14 months. RESULTS A total of seven male patients from July 2019 to 2020 were admitted to our center with a history of repaired bladder exstrophy and reducible inguinal hernias. Two patients had open inguinal hernia repair due to parental preference and five patients had laparoscopic repair. In the laparoscopic group three patients had bilateral inguinal hernias in one of them a metachronous hernia was discovered intraoperstively, and the remaining two patients had unilateral hernias, one on the right side and the other on the left side. All patients in the laparoscopic group had an uneventful recovery and were discharged within 24 h and there were no complications or recurrences during follow-up. CONCLUSION Laparoscopic inguinal hernia repair is a better alternative to managing inguinal hernias in children with bladder exstrophy.
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Affiliation(s)
- Heba Taher
- Pediatric Surgery Cairo University, Egypt.
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Lee T, Vasquez E, Logvinenko T, Venna A, Frazier J, Lingongo M, Roth E, Weiss D, Groth T, Shukla A, Kryger JV, Canning DA, Mitchell ME, Borer JG. Timing of inguinal hernia following complete primary repair of bladder exstrophy. J Pediatr Urol 2021; 17:87.e1-87.e6. [PMID: 33317945 PMCID: PMC8329731 DOI: 10.1016/j.jpurol.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/27/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION/BACKGROUND Bladder exstrophy patients have a high prevalence of inguinal hernia that often become clinically evident following bladder closure. Understanding when the bladder exstrophy patient is under greatest risk of developing an inguinal hernia following bladder closure is important, since incarceration resulting in strangulation of intra-abdominal contents can lead to significant morbidity if not addressed in a timely fashion. Although the incidence and risk factors of inguinal hernia have been reported, the timing of occurrence is not well understood. OBJECTIVE The primary objective of this study was to assess the timing of inguinal hernia following complete primary repair of bladder exstrophy (CPRE). In addition, we aimed to evaluate possible risk factors associated with inguinal hernia, including sex, age at bladder closure and iliac osteotomy status. STUDY DESIGN A multi-institutional retrospective review identified patients with bladder exstrophy repaired by CPRE under 6 months of age while excluding those who underwent inguinal hernia repair before or during bladder closure. Timing of inguinal hernia following bladder closure was evaluated using Kaplan-Meier methods. Cox proportional hazards model was used to investigate association of sex, age at bladder closure, and osteotomy on the risk of developing of inguinal hernia while clustering for institution. RESULTS 91 subjects were included in our analysis with median follow-up time of 6.5 years. 34 of 53 males (64.2%) and 2 of 38 females (5.3%) underwent inguinal hernia repair. The median time to inguinal hernia was 4.7 months following closure. The greatest hazard of inguinal hernia was within the first six months following closure. In multivariate analysis, male sex was strongly associated with inguinal hernia (HR = 19.00, p = 0.0038). Osteotomy and delay in closure were not significantly associated with inguinal hernia. 7 of 36 patients (19.4%) who underwent inguinal hernia repair presented with recurrence on the ipsilateral side. DISCUSSION Our results suggest that the greatest risk of inguinal hernia is within the first six months following bladder closure. The decreased risk of inguinal hernia after one year of follow-up may reflect anatomic stability that is reached following major reconstruction of the pelvis. While male bladder exstrophy patients are significantly more susceptible to inguinal hernias following CPRE, osteotomy and delayed bladder closure do not appear to be protective factors for inguinal hernia development following initial bladder closure. CONCLUSIONS There is a heightened risk of inguinal hernia in the first six months following closure. The rate of recurrence following inguinal hernia repair is significantly elevated compared to the general pediatric population.
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Affiliation(s)
- Ted Lee
- Boston Children's Hospital, Department of Urology, 300 Longwood Avenue Boston, MA 02115, USA.
| | - Evalynn Vasquez
- Boston Children's Hospital, Department of Urology, 300 Longwood Avenue Boston, MA 02115, USA
| | - Tanya Logvinenko
- Children's Hospital of Wisconsin, Division of Urology, 8915 West Connell Court, Milwaukee, WI 53226, USA
| | - Alyssia Venna
- Boston Children's Hospital, Department of Urology, 300 Longwood Avenue Boston, MA 02115, USA
| | - Jennifer Frazier
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Boulevard Philadelphia, PA 19104, USA
| | - Melissa Lingongo
- Children's Hospital of Wisconsin, Division of Urology, 8915 West Connell Court, Milwaukee, WI 53226, USA
| | - Elizabeth Roth
- Children's Hospital of Wisconsin, Division of Urology, 8915 West Connell Court, Milwaukee, WI 53226, USA
| | - Dana Weiss
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Boulevard Philadelphia, PA 19104, USA
| | - Travis Groth
- Children's Hospital of Wisconsin, Division of Urology, 8915 West Connell Court, Milwaukee, WI 53226, USA
| | - Aseem Shukla
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Boulevard Philadelphia, PA 19104, USA
| | - John V Kryger
- Children's Hospital of Wisconsin, Division of Urology, 8915 West Connell Court, Milwaukee, WI 53226, USA
| | - Douglas A Canning
- Children's Hospital of Philadelphia, Division of Urology, 3401 Civic Center Boulevard Philadelphia, PA 19104, USA
| | - Michael E Mitchell
- Children's Hospital of Wisconsin, Division of Urology, 8915 West Connell Court, Milwaukee, WI 53226, USA
| | - Joseph G Borer
- Boston Children's Hospital, Department of Urology, 300 Longwood Avenue Boston, MA 02115, USA
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Ebert AK, Zwink N, Reutter HM, Jenetzky E, Stein R, Hölscher AC, Lacher M, Fortmann C, Obermayr F, Fisch M, Mortazawi K, Schmiedeke E, Promm M, Hirsch K, Schäfer FM, Rösch WH. Treatment Strategies and Outcome of the Exstrophy-Epispadias Complex in Germany: Data From the German CURE-Net. Front Pediatr 2020; 8:174. [PMID: 32509709 PMCID: PMC7248227 DOI: 10.3389/fped.2020.00174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: To evaluate the impact of reconstructive strategies and post-operative management on short- and long-term surgical outcome and complications of classical bladder exstrophy (CBE) patients' comprehensive data of the multicenter German-wide Network for Congenital Uro-Rectal malformations (CURE-Net) were analyzed. Methods: Descriptive analyses were performed between 34 prospectively collected CBE patients born since 2009, median 3 months old [interquartile range (IQR), 2-4 months], and 113 cross-sectional patients, median 12 years old (IQR, 6-21 years). Results: The majority of included individuals were males (67%). Sixty-eight percent of the prospectively observed and 53% of the cross-sectional patients were reconstructed using a staged approach (p = 0.17). Although prospectively observed patients were operated on at a younger age, the post-operative management did not significantly change in the years before and after 2009. Solely, in prospectively observed patients, peridural catheters were used significantly more often (p = 0.017). Blood transfusions were significantly more frequent in males (p = 0.002). Only half of all CBE individuals underwent inguinal hernia repair. Cross-sectional patients after single-stage reconstructions showed more direct post-operative complications such as upper urinary tract dilatations (p = 0.0021) or urinary tract infections (p = 0.023), but not more frequent renal function impairment compared to patients after the staged approach (p = 0.42). Continence outcomes were not significantly different between the concepts (p = 0.51). Self-reported continence data showed that the majority of the included CBE patients was intermittent or continuous incontinent. Furthermore, subsequent consecutive augmentations and catheterizable stomata did not significantly differ between the two operative approaches. Urinary diversions were only reported after the staged concept. Conclusions: In this German multicenter study, a trend toward the staged concept was observed. While single-stage approaches tended to have initially more complications such as renal dilatation or urinary tract infections, additional surgery such as augmentations and stomata appeared to be similar after staged and single-stage reconstructions in the long term.
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Affiliation(s)
- Anne-Karoline Ebert
- Department of Pediatric Urology, University Hospital for Urology and Pediatric Urology, University Medical Center Ulm, Ulm, Germany
| | - Nadine Zwink
- Department of Child and Adolescent Psychiatry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heiko M Reutter
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Ekkehart Jenetzky
- Department of Child and Adolescent Psychiatry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Child Center Maulbronn GmbH, Hospital for Pediatric Neurology and Social Pediatrics, Maulbronn, Germany
| | - Raimund Stein
- Department of Pediatric and Adolescent Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Alice C Hölscher
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital Amsterdamer Straße Köln, Köln, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Caroline Fortmann
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Florian Obermayr
- Department of Pediatric Surgery and Pediatric Urology, University Hospital for Child and Adolescent Medicine Tübingen, Tübingen, Germany
| | - Margit Fisch
- Department of Urology and Pediatric Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kiarasch Mortazawi
- Department of Pediatric Surgery, Klinik für Kinderchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Pediatric Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Martin Promm
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
| | - Karin Hirsch
- Department of Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Frank-Mattias Schäfer
- Pediatric Surgery and Pediatric Urology, Cnopfsche Children's Hospital, Nürnberg, Germany
| | - Wolfgang H Rösch
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
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Preece J, Asti L, Ambeba E, McLeod DJ. Peri-operative transfusion risk in classic bladder exstrophy closure: Results from a national database review. J Pediatr Urol 2016; 12:208.e1-6. [PMID: 27282549 DOI: 10.1016/j.jpurol.2016.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/22/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Classic bladder exstrophy (CBE) is one of the most complex pediatric urologic conditions, with patients often requiring multiple procedures throughout their lives. Patients undergoing these complex surgeries may require blood transfusion, exposing them to the risks of transfusion including antibody reactions, transmission of infectious diseases, and transfusion-related immunomodulation. We sought to determine the prevalence of and risk factors for peri-operative transfusion in patients undergoing closure for CBE. Because of the complexity of CBE management, we hypothesized that a significant number of patients undergoing closure of CBE would require peri-operative transfusion. METHOD Patients undergoing CBE closure between 2012 and 2014 were retrospectively identified by Current Procedure Terminology codes from The National Surgical Quality Improvement Program Pediatric database, which includes data from 64 participating hospitals. Patient demographics, pre-operative characteristics including comorbidities, intra-operative characteristics, and post-operative outcomes were analyzed for associations with transfusion requirement intra-operatively or in the first 72 h post-operatively. RESULTS Seventy-eight patients met our criteria, of whom 45 (57.7%) underwent transfusion. Patient characteristics and outcomes are noted in the Table. There was no difference between the groups in terms of age or gender. Patients who underwent transfusion were more likely to be over 3 days of age than those who did not (93.3% versus 75.8%; p = 0.046). Transfused patients were also more likely to have undergone osteotomy (82.2% versus 48.5%; p = 0.002), had an external fixation (46.7% versus 6.1%; p < 0.001), had longer median operative times (447 versus 295 min; p < 0.001), and had longer median post-operative lengths of stay (LOS) (35 versus 17 days; p = 0.003). There was no difference between the groups in terms of pre-operative risk factors or post-operative complications. CONCLUSIONS A significant number of patients undergoing CBE closure required transfusion in the peri-operative period (57.7%). Patient characteristics found to have a higher rate of transfusion included osteotomy, external fixation, increased operative times, and longer post-operative LOS. In children undergoing closure for CBE, a large number require transfusion. The rate of transfusion is greater in older children and children undergoing osteotomy. Although osteotomy has a potentially important clinical role, especially in older patients, this study emphasizes the need for proper family counseling to include the increased likelihood of a blood transfusion and the risks associated with blood transfusion if osteotomies are performed.
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Affiliation(s)
- Janae Preece
- Section of Pediatric Urology at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Lindsey Asti
- Nationwide Children's Hospital Center for Surgical Outcomes Research, Columbus, OH, USA
| | - Erica Ambeba
- Nationwide Children's Hospital Center for Surgical Outcomes Research, Columbus, OH, USA
| | - Daryl J McLeod
- Section of Pediatric Urology at Nationwide Children's Hospital, Columbus, OH, USA; Nationwide Children's Hospital Center for Surgical Outcomes Research, Columbus, OH, USA
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Ellison JS, Shnorhavorian M, Merguerian PA, Grady R. Impact of concomitant hernia repair at the time of complete primary repair of bladder exstrophy. J Pediatr Urol 2016; 12:211.e1-5. [PMID: 27264049 DOI: 10.1016/j.jpurol.2016.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/30/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Inguinal hernias are common in the bladder exstrophy population. As these hernias may present with incarceration following bladder closure, several groups recommend inguinal exploration and hernia repair at the time of initial bladder closure. However, the benefits of such an approach are not well defined. In 2006, we modified our approach to this condition by routinely performing concomitant inguinal herniorraphy (CIH) repair at the time of initial exstrophy repair. The aim of this study was to test the hypothesis that simultaneous inguinal hernia repair will be safe and effective in reducing subsequent unplanned inguinal procedures in this high-risk group. METHOD We conducted a retrospective chart review of patients with classic bladder exstrophy managed with complete primary repair (CPRE) from 1990 to 2014, with focus on inguinal hernia repair at the time of bladder closure and subsequent need for inguinal surgery. We excluded patients with follow-up less than 6 months, missing data with regards to the initial inguinal approach at the time of bladder closure, and patients with intra-abdominal testicles. RESULTS A total of 43 patients were included for analysis with 27 (61%) having inguinal hernias identified either at birth or in subsequent follow-up, including 20 of 27 boys and 7 of 16 girls. A summary of comparison groups with and without CIH at the time of CPRE, as well as follow-up and need for subsequent hernia repair, is given in the summary Table. Of 25 patients without concomitant inguinal herniorraphy at CPRE, 10 patients required subsequent inguinal surgeries for inguinal herniorraphy (seven), orchiopexy (one), or inguinal herniorraphy plus orchiopexy (two). CONCLUSION CIH at the time of CPRE is safe, with no significant inguinal complications noted. Subsequent inguinal operations were more often required in the cohort of patients not receiving CIH at the time of CPRE, including one patient presenting with incarceration. Thus, CIH appears to reduce need for subsequent inguinal operations when performed at the time of bladder closure. Our study adds to other authors' claims that CIH should be attempted at the time of bladder closure. This study is limited by the retrospective nature of the review and differences in follow-up times between groups. Simultaneous inguinal hernia repair at the time of initial exstrophy repair is safe and associated with decreased incidence of subsequent inguinal surgery. Such an approach should be undertaken during initial bladder closure.
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