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December 1989, Vol 143, No. 12 >
Article | December 1989

State-of-the-Art Reconstructive Surgery for Bladder Exstrophy at The Johns Hopkins Hospital FREE

John P. Gearhart, MD; Robert D. Jeffs, MD
[+] Author Affiliations

Accepted for publication June 2, 1989.

Reprint requests to Division of Pediatric Urology, The Johns Hopkins Hospital, Baltimore, MD 21205 (Dr Jeffs).


Am J Dis Child. 1989;143(12):1475-1478. doi:10.1001/archpedi.1989.02150240097026.
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• Bladder exstrophy is a congenital anomaly that has been difficult to correct. Advances in reconstructive surgery, some of which have originated at The Johns Hopkins Hospital, Baltimore, Md, have impacted on the care of these patients. We reviewed the progress made in patient care and the results of state-of-the-art treatment.

(AJDC. 1989;143:1475-1478)

REFERENCES

1 +
Trendelenburg R.  The treatment of ectopia vesicae . Ann Surg . 1906;;44:281-284.
2 +
Burns JE.  A new operation for exstrophy of the bladder . JAMA . 1924;;82:1587-1598.
3 +
Magdl K.  Uber die Radikaltherapie der blasen Ectopie . Wien Med Wochenschr . 1894;;45:1113-1117.
4 +
Coffey RC.  Transplantation of the ureter into the large intestine in the absence of a functioning bladder . Surg Gynecol Obstet . 1921;;32:383-389.
5 +
Nesbit RM.  Ureterosigmoid anastomosis by direct eliptical connection: a preliminary report . J Urol . 1949;;61:728-734.
6 +
Leadbetter WF, Clark BG.  Consideration of problems incident to performance of ureteroenterostomy: report of a technique . J Urol . 1950;;73:62-82.
7 +
Boyce WH, Vest SA.  A new concept concerning treatment of exstrophy of the bladder . J Urol . 1952;;67:503-517.
8 +
Taccinoli M, Laurenti C, Racheli T.  Sixteen years' experience with the Heitz-Boyer-Hovalacque procedure for exstrophy of the bladder . Br J Urol . 1977;;49:385-390.
9 +
Jeffs RD, Schwartz GR.  Ileal conduit urinary diversion in children: computer analysis follow-up from 2 to 16 years . J Urol . 1975;;114:285-288.
10 +
Hendren WH.  Exstrophy of the bladder: an alternative method of management . J Urol . 1976;;115:195-198.
11 +
Young HH.  Exstrophy of the bladder: the first case in which a normal bladder and urinary control have been obtained by plastic operation . Surg Gynecol Obstet . 1942;;74:729-733.
12 +
Dees JE.  Congenital epispadias with incontinence . J Urol . 1949;;62:513-522.
13 +
Williams DI, Keaton J.  Vesical exstrophy: 20 years'experience . Br J Surg . 1973;;60:203-207.
14 +
Schultz WG.  Plastic repair of exstrophy of the bladder combined with bilateral osteotomy of the ilia . J Urol . 1958;;79:453-458.
15 +
Cendron J.  Treatment of bladder exstrophy . Ann Chir Infant . 1982;;12:974-979.
16 +
Marshall VF, Muecke EC.  Functional closure of typical exstrophy of the bladder . J Urol . 1970;;104:205-208.
17 +
Lattimer JK, Beck L, Yeaw S, et al.  Long-term follow-up after exstrophy closure: late improvement and good quality of life . J Urol . 1978;;119:664-666.
18 +
Culp DA.  The histology of the exstrophied bladder . J Urol . 1964;;91:538-548.
19 +
Ansell JS.  Surgical treatment of exstrophy of the bladder with emphasis on neonatal primary closure: personal experience with 28 consecutive cases treated at the University of Washington Hospitals from 1962 to 1978: techniques and results . J Urol . 1979;;121:650-653.
20 +
Johnston H, Kogan SJ.  Exstrophic anomalies and their surgical reconstruction . Curr Probl Surg . 1974;;9:1-39.
21 +
Chisholm TC.  Exstrophy of the urinary bladder . In: Kiesewetter WB, ed. Long-term Follow Up in Congenital Anomalies . Pittsburgh, Pa: Pittsburgh Children's Hospital; 1979;;6:31-35.
22 +
Jeffs RD, Guice SL, Oesch I.  The factors in successful exstrophy closure . J Urol . 1982;;127:974-976.
23 +
Lowe FC, Jeffs RD.  Wound dehiscence in bladder exstrophy: an examination of the etiologies and factors for initial failure and subsequent closure . J Urol . 1983;;130:312-315.
24 +
Shapiro E, Jeffs RD, Gearhart JP, Lepor H.  Muscarinic cholinergic receptors in closed exstrophied bladders . J Urol . 1985;;134:308-310.
25 +
Shapiro E, Lepor H, Jeffs RD.  The inheritance of classic bladder exstrophy . J Urol . 1984;; 132:308-311.
26 +
Engel RM, Wilkinson HA.  Bladder exstrophy . J Urol . 1970;;104:699-704.
27 +
Gearhart JP, Williams KA, Jeffs RD.  Intraoperative urethral pressure profilometry as an adjunct to bladder neck reconstruction . J Urol . 1986;;136:1055-1056.
28 +
Gearhart JP, Jeffs RD.  Augmentation cystoplasty in the failed exstrophy reconstruction . J Urol . 1988;;129:790-792.
29 +
Gearhart JP, Jeffs RD.  Bladder exstrophy: the small bladder after closure . J Urol . 1989;; 142:525-562.
30 +
Johnston JH.  The genital aspects of exstrophy . J Urol . 1975;;113:701-705.
31 +
Duckett JW.  Use of paraexstrophy skin pedicle grafts for exstrophy and epispadias repair . Birth Defects . 1977;;13:171-178.
32 +
Toguri AG, Churchill BN, Schillinger JF, Jeffs RD.  Gas cystometry in cases of continent bladder exstrophy . J Urol . 1978;;119:536-537.
33 +
Husmann DA, McLorie GA, Churchill, BN.  Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence . J Urol . 1989;;142:522-524.
34 +
Rapp S, Giron A, Degoe JN.  Complete reconstruction of bladder exstrophy . Urology . 1976;; 7:413-416.
35 +
Light JK, Engelmann UH.  Reconstruction of the lower urinary tract: observations on bowel dynamics and the artificial urinary sphincter . J Urol . 1985;;133:594-597.
36 +
Leadbetter GW Jr.  Surgical correction of total urinary incontinence . J Urol . 1964;;91:261-266.
37 +
Gearhart JP, Jeffs RD.  Complications of exstrophy and epispadias . In: Smith RB, Ehrlich RM, eds. Complications in Urologic Surgery . Philadelphia, Pa: WB Saunders Co; 1989;.
38 +
Sponseller PC, Gearhart JP, Jeffs RD. Anterior iliac osteotomy in the exstrophy patient. Presented as a poster exhibit at the American Urological Association; June 10, 1988; Boston, Mass.
39 +
Jeffs RD, Lepor H.  Management of the exstrophy-epispadias complex . In: Walsh PC, Gittes RF, Perlmutter AD, Stamey TA, eds. Campbell's Textbook of Urology . Philadelphia, Pa: WB Saunders Co; 1986;:1882-1919.
40 +
Cohen SJ.  Ureterozysloneostomie: ein neue antireflux Technik . Aktuel Urol . 1975;;6:24-27.
41 +
Lepor H, Jeffs RD.  Primary bladder closure and bladder neck reconstruction in classical bladder exstrophy . J Urol . 1983;;130:1142-1145.
42 +
Mollard P.  Bladder reconstruction in exstrophy . J Urol . 1980;;124:525-529.
43 +
Oesterling JE, Jeffs RD.  The importance of a successful initial bladder closure in the surgical treatment of classical bladder exstrophy: analysis of 144 patients with bladder exstrophy treated at The Johns Hopkins Hospital from 1975 to 1985 . J Urol . 1987;;137:258-262.
44 +
Hanna MK, Williams DI.  Genital function in males with vesical exstrophy and epispadias . Br J Urol . 1972;;44:169-174.
45 +
Kandzari SJ, Majid A, Ortega AM, Milam DF.  Exstrophy of the urinary bladder complicated by adenocarcinoma . Urology . 1974;;3:496-498.
46 +
Smerdjian HS, Texter JH, Yawn DH.  Rhabdomyosarcoma occurring in repaired exstrophic bladder: case report . J Urol . 1972;;108:354-356.
47 +
Spence HM, Hoffman WW, Fausmyer PP.  Tumors of the colon as a later complication of a ureterosigmoidostomy for exstrophy of the bladder . Br J Urol . 1979;;51:466-470.
48 +
Woodhouse CR, Ransley PC, Williams DI.  The exstrophy patient in adult life . Br J Urol . 1983;;55:632-635.
49 +
Gearhart JP, Jeffs RD.  The use of parenteral testosterone in genital reconstructive surgery . J Urol . 1987;;138:1077-1078.
50 +
Mitrofanoff P.  Cystostomie continente trans-appendiculaire dans le traitment: des vessies neurologiques . Chir Pediatr . 1980;;21:297-302.
51 +
Rowland RG, Mitchell ME, Bihrle R.  The cecoileal continent urinary reservoir . World J Urol . 1985;;3:185-190.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Trendelenburg R.  The treatment of ectopia vesicae . Ann Surg . 1906;;44:281-284.
2 +
Burns JE.  A new operation for exstrophy of the bladder . JAMA . 1924;;82:1587-1598.
3 +
Magdl K.  Uber die Radikaltherapie der blasen Ectopie . Wien Med Wochenschr . 1894;;45:1113-1117.
4 +
Coffey RC.  Transplantation of the ureter into the large intestine in the absence of a functioning bladder . Surg Gynecol Obstet . 1921;;32:383-389.
5 +
Nesbit RM.  Ureterosigmoid anastomosis by direct eliptical connection: a preliminary report . J Urol . 1949;;61:728-734.
6 +
Leadbetter WF, Clark BG.  Consideration of problems incident to performance of ureteroenterostomy: report of a technique . J Urol . 1950;;73:62-82.
7 +
Boyce WH, Vest SA.  A new concept concerning treatment of exstrophy of the bladder . J Urol . 1952;;67:503-517.
8 +
Taccinoli M, Laurenti C, Racheli T.  Sixteen years' experience with the Heitz-Boyer-Hovalacque procedure for exstrophy of the bladder . Br J Urol . 1977;;49:385-390.
9 +
Jeffs RD, Schwartz GR.  Ileal conduit urinary diversion in children: computer analysis follow-up from 2 to 16 years . J Urol . 1975;;114:285-288.
10 +
Hendren WH.  Exstrophy of the bladder: an alternative method of management . J Urol . 1976;;115:195-198.
11 +
Young HH.  Exstrophy of the bladder: the first case in which a normal bladder and urinary control have been obtained by plastic operation . Surg Gynecol Obstet . 1942;;74:729-733.
12 +
Dees JE.  Congenital epispadias with incontinence . J Urol . 1949;;62:513-522.
13 +
Williams DI, Keaton J.  Vesical exstrophy: 20 years'experience . Br J Surg . 1973;;60:203-207.
14 +
Schultz WG.  Plastic repair of exstrophy of the bladder combined with bilateral osteotomy of the ilia . J Urol . 1958;;79:453-458.
15 +
Cendron J.  Treatment of bladder exstrophy . Ann Chir Infant . 1982;;12:974-979.
16 +
Marshall VF, Muecke EC.  Functional closure of typical exstrophy of the bladder . J Urol . 1970;;104:205-208.
17 +
Lattimer JK, Beck L, Yeaw S, et al.  Long-term follow-up after exstrophy closure: late improvement and good quality of life . J Urol . 1978;;119:664-666.
18 +
Culp DA.  The histology of the exstrophied bladder . J Urol . 1964;;91:538-548.
19 +
Ansell JS.  Surgical treatment of exstrophy of the bladder with emphasis on neonatal primary closure: personal experience with 28 consecutive cases treated at the University of Washington Hospitals from 1962 to 1978: techniques and results . J Urol . 1979;;121:650-653.
20 +
Johnston H, Kogan SJ.  Exstrophic anomalies and their surgical reconstruction . Curr Probl Surg . 1974;;9:1-39.
21 +
Chisholm TC.  Exstrophy of the urinary bladder . In: Kiesewetter WB, ed. Long-term Follow Up in Congenital Anomalies . Pittsburgh, Pa: Pittsburgh Children's Hospital; 1979;;6:31-35.
22 +
Jeffs RD, Guice SL, Oesch I.  The factors in successful exstrophy closure . J Urol . 1982;;127:974-976.
23 +
Lowe FC, Jeffs RD.  Wound dehiscence in bladder exstrophy: an examination of the etiologies and factors for initial failure and subsequent closure . J Urol . 1983;;130:312-315.
24 +
Shapiro E, Jeffs RD, Gearhart JP, Lepor H.  Muscarinic cholinergic receptors in closed exstrophied bladders . J Urol . 1985;;134:308-310.
25 +
Shapiro E, Lepor H, Jeffs RD.  The inheritance of classic bladder exstrophy . J Urol . 1984;; 132:308-311.
26 +
Engel RM, Wilkinson HA.  Bladder exstrophy . J Urol . 1970;;104:699-704.
27 +
Gearhart JP, Williams KA, Jeffs RD.  Intraoperative urethral pressure profilometry as an adjunct to bladder neck reconstruction . J Urol . 1986;;136:1055-1056.
28 +
Gearhart JP, Jeffs RD.  Augmentation cystoplasty in the failed exstrophy reconstruction . J Urol . 1988;;129:790-792.
29 +
Gearhart JP, Jeffs RD.  Bladder exstrophy: the small bladder after closure . J Urol . 1989;; 142:525-562.
30 +
Johnston JH.  The genital aspects of exstrophy . J Urol . 1975;;113:701-705.
31 +
Duckett JW.  Use of paraexstrophy skin pedicle grafts for exstrophy and epispadias repair . Birth Defects . 1977;;13:171-178.
32 +
Toguri AG, Churchill BN, Schillinger JF, Jeffs RD.  Gas cystometry in cases of continent bladder exstrophy . J Urol . 1978;;119:536-537.
33 +
Husmann DA, McLorie GA, Churchill, BN.  Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence . J Urol . 1989;;142:522-524.
34 +
Rapp S, Giron A, Degoe JN.  Complete reconstruction of bladder exstrophy . Urology . 1976;; 7:413-416.
35 +
Light JK, Engelmann UH.  Reconstruction of the lower urinary tract: observations on bowel dynamics and the artificial urinary sphincter . J Urol . 1985;;133:594-597.
36 +
Leadbetter GW Jr.  Surgical correction of total urinary incontinence . J Urol . 1964;;91:261-266.
37 +
Gearhart JP, Jeffs RD.  Complications of exstrophy and epispadias . In: Smith RB, Ehrlich RM, eds. Complications in Urologic Surgery . Philadelphia, Pa: WB Saunders Co; 1989;.
38 +
Sponseller PC, Gearhart JP, Jeffs RD. Anterior iliac osteotomy in the exstrophy patient. Presented as a poster exhibit at the American Urological Association; June 10, 1988; Boston, Mass.
39 +
Jeffs RD, Lepor H.  Management of the exstrophy-epispadias complex . In: Walsh PC, Gittes RF, Perlmutter AD, Stamey TA, eds. Campbell's Textbook of Urology . Philadelphia, Pa: WB Saunders Co; 1986;:1882-1919.
40 +
Cohen SJ.  Ureterozysloneostomie: ein neue antireflux Technik . Aktuel Urol . 1975;;6:24-27.
41 +
Lepor H, Jeffs RD.  Primary bladder closure and bladder neck reconstruction in classical bladder exstrophy . J Urol . 1983;;130:1142-1145.
42 +
Mollard P.  Bladder reconstruction in exstrophy . J Urol . 1980;;124:525-529.
43 +
Oesterling JE, Jeffs RD.  The importance of a successful initial bladder closure in the surgical treatment of classical bladder exstrophy: analysis of 144 patients with bladder exstrophy treated at The Johns Hopkins Hospital from 1975 to 1985 . J Urol . 1987;;137:258-262.
44 +
Hanna MK, Williams DI.  Genital function in males with vesical exstrophy and epispadias . Br J Urol . 1972;;44:169-174.
45 +
Kandzari SJ, Majid A, Ortega AM, Milam DF.  Exstrophy of the urinary bladder complicated by adenocarcinoma . Urology . 1974;;3:496-498.
46 +
Smerdjian HS, Texter JH, Yawn DH.  Rhabdomyosarcoma occurring in repaired exstrophic bladder: case report . J Urol . 1972;;108:354-356.
47 +
Spence HM, Hoffman WW, Fausmyer PP.  Tumors of the colon as a later complication of a ureterosigmoidostomy for exstrophy of the bladder . Br J Urol . 1979;;51:466-470.
48 +
Woodhouse CR, Ransley PC, Williams DI.  The exstrophy patient in adult life . Br J Urol . 1983;;55:632-635.
49 +
Gearhart JP, Jeffs RD.  The use of parenteral testosterone in genital reconstructive surgery . J Urol . 1987;;138:1077-1078.
50 +
Mitrofanoff P.  Cystostomie continente trans-appendiculaire dans le traitment: des vessies neurologiques . Chir Pediatr . 1980;;21:297-302.
51 +
Rowland RG, Mitchell ME, Bihrle R.  The cecoileal continent urinary reservoir . World J Urol . 1985;;3:185-190.

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