Minimally invasive approach as an ancillary intervention post adult primary bladder exstrophy closure: Minimizing the morbidity

Sidhartha Kalra, Poojan thakor, L.N. Dorairajan, K.S. Sreerag, Vishal Narkhede, Siddhant Bolar
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Abstract

Introduction and objectives

The exstrophy-epispadias complex, including classical and cloacal exstrophy, significantly impacts physical, functional, and psychological health. Adults with primary bladder exstrophy repair often face persistent urinary incontinence due to a patulous bladder neck and reduced bladder capacity. Previous surgeries increase the risks of open procedures. Various studies have used open augmentation cystoplasty and robotic approaches in pediatric patients, not as minimally invasive techniques in adult patients with post exstrophy repair issues. We describe Robotic surgical augmentation cystoplasty which offers a minimally invasive alternative with promising outcomes, reducing postoperative complications, and facilitating adjunct procedures for post-bladder exstrophy repair issues.

Patients and surgical procedure

This study presents three urological reconstruction cases. The first involves a patient with primary bladder exstrophy and epispadias repair facing urinary incontinence and limited bladder capacity. The second involves a post-bladder exstrophy repair patient with bladder neck reconstruction in childhood. Both above patient underwent Robotic augmentation cystoplasty. The third case discusses a patient with continuous urinary incontinence post-primary exstrophy repair, treated with robotic Kropp's repair and augmentation cystoplasty.

Results

All patients maintained normal renal function without complications. Two patients had no postoperative issues and a urine holding capacity of two hours. The Kropp's procedure patient had less capacity and more frequent micturition. All patients were cosmetically satisfied.

Conclusion

Robotic augmentation cystoplasty is a minimally invasive solution for small bladder capacity post-bladder exstrophy repair in adults. It improves urine holding capacity and minimizes postoperative complications, enhancing urological reconstruction and quality of life for these patients.

微创方法作为成人原发性膀胱外翻闭合术后的辅助干预措施:最大限度降低发病率
导言和目的膀胱外翻-尿道外翻综合症,包括典型的膀胱外翻和泄殖腔外翻,对身体、功能和心理健康造成严重影响。接受原发性膀胱外翻修复术的成人通常会因膀胱颈部发育不良和膀胱容量减少而面临持续性尿失禁。以往的手术增加了开放手术的风险。多项研究已在儿科患者中使用了开放式增大膀胱成形术和机器人方法,但在有膀胱外翻修复术后问题的成人患者中并未使用微创技术。我们介绍了机器人手术增大膀胱成形术,它提供了一种微创替代方案,具有良好的效果,减少了术后并发症,并促进了膀胱萎缩后修复问题的辅助手术。患者和手术过程本研究介绍了三个泌尿系统重建病例。第一个病例涉及一名原发性膀胱外翻和尿道外裂修复术后患者,患者面临尿失禁和膀胱容量受限的问题。第二个病例涉及一名膀胱外翻修复术后的儿童膀胱颈重建患者。上述两名患者均接受了机器人膀胱成形术。第三个病例讨论的是一名原发性膀胱外翻修复术后持续尿失禁的患者,该患者接受了机器人克罗普氏修复术和增大膀胱成形术。两名患者术后无任何问题,憋尿时间长达两小时。克罗普氏手术患者的憋尿能力较弱,排尿次数较多。结论机器人膀胱成形术是一种微创解决方案,适用于成人膀胱萎缩修复术后膀胱容量较小的情况。结论机器人膀胱成形术是成人膀胱萎缩修复术后小容量膀胱的微创解决方案,它能提高憋尿能力,减少术后并发症,改善泌尿系统重建,提高患者的生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Urology video journal
Urology video journal Nephrology, Urology
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