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533 URINARY CONTINENCE AND THE UPPER TRACT IN EXSTROPHY-EPISPADIA: A SINGLE CENTER EXPERIENCE

2010; Lippincott Williams & Wilkins; Volume: 183; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2010.02.732

1527-3792

Jovelino Quintino de Souza Leão, Adriano Luís Gomes, Luciano Silveira Onofre, Antonio Carlos Heinisch, Rafael Ribeiro Correia, Giselle Cunha Machado, Tatianne Costa, José Carnevale,

Ureteral procedures and complications

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2010533 URINARY CONTINENCE AND THE UPPER TRACT IN EXSTROPHY-EPISPADIA: A SINGLE CENTER EXPERIENCE Jovelino Leao, Adriano Gomes, Luciano Onofre, Antonio Heinisch, Rafael Correia, Giselle Machado, Tatianne Costa, and José Carnevale Jovelino LeaoJovelino Leao More articles by this author , Adriano GomesAdriano Gomes More articles by this author , Luciano OnofreLuciano Onofre More articles by this author , Antonio HeinischAntonio Heinisch More articles by this author , Rafael CorreiaRafael Correia More articles by this author , Giselle MachadoGiselle Machado More articles by this author , Tatianne CostaTatianne Costa More articles by this author , and José CarnevaleJosé Carnevale More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.732AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract reconstruction in exstrophic patients may need various procedures. Obstruction, lithiasis and pyelonephritis, cause progressive upper tract damages decreasing renal function. The aim of this study is to evaluate urinary continence and the upper tract of exstrophy-epispadia patients relating to surgical treatment METHODS Retrospective study of exstrophy-epispadia complex patients submitted to surgical reconstruction in a single institution. Upper tract was evaluated with sonography, renal scintigraphy (DMSA) in conjunction with venous gasometry, creatinin level and clearance. Results were related to surgical procedures undertaken to provide continence. RESULTS From 1978 to 2009, 123 patients were treated. 86 classical bladder exstrophy (including six variants), 11 cloacal exstrophy and 26 epispadia. 4 classical exstrophy patients lost follow-up. Normal renal status was found in 41 (50%) of 82 bladder exstrophy patients. In 23 patients (28%) one or both kidneys presented heterogeneity in DMSA. Decreased renal function detected in 9 patients with mild acidosis (11,1%). Hydroureteronephrosis occurred in 21 patients (25,6%). 3 patients evolved renal failure and two of them were submitted to kidney transplantation. Two patients died on long-term follow-up, one due to post-transplant complications. Seventy-six classical bladder exstrophy patients remain in follow-up, and 56 (73,7%) were continent (dry on 3-hour intervals) while 20 remain incontinent (26,3%) but six of them under 5-year age not submitted to any continence procedure. Of the continent group, 26 (46,4%) were submitted to bladder neck closure after two or more unsuccessful bladder neck repairs and eleven maintain normal renal function. Twelve patients evolved with mild renal insufficiency and three with end stage renal disease. Twenty-two (39,3%) patients had bladder augmentation, bladder neck reconstruction and Mitrofanoff procedure remaining with normal renal function in 16, 3 with mild renal insufficiency and other three on renal failure. Only 3 patients were submitted just to bladder neck reconstruction; one patient had just bladder augmentation, and the other just Mitrofanoff for bladder catheterization. CONCLUSIONS Upper tract of exstrophy patients may be damaged if continence procedures were not followed closely. Continence with bladder neck closure did not correlate with upper tract deterioration in large capacity reservoirs. Most frequent procedure performed was bladder neck reconstruction with bladder augmentation and catheterization conduit Sao Paulo, Brazil© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e210 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jovelino Leao More articles by this author Adriano Gomes More articles by this author Luciano Onofre More articles by this author Antonio Heinisch More articles by this author Rafael Correia More articles by this author Giselle Machado More articles by this author Tatianne Costa More articles by this author José Carnevale More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...