Cloacal Exstrophy: a complex disease

Detalhes bibliográficos
Autor(a) principal: Macedo Jr,Antonio
Data de Publicação: 2013
Outros Autores: Rondon,Atila, Frank,Ricardo, Bacelar,Herick, Leslie,Bruno, Ottoni,Sergio, Garrone,Gilmar, Liguori,Riberto, Ortiz,Valdemar
Tipo de documento: Artigo
Idioma: eng
Título da fonte: International Braz J Urol (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382013000600897
Resumo: Introduction Cloacal exstrophy is a rare occurrence with an incidence of 1:200,000 to 1:400,000 live births. It represents one of the most challenging reconstructive endeavors faced by pediatric surgeons and urologists. Aside from the genitourinary defects, there are other associated anomalies of the gastrointestinal, musculoskeletal and neurological systems that require a multidisciplinary approach when counseling anxious parents. Material and Methods We present a video of a patient with cloacal exstrophy treated with 21 days of life. Surgery consisted of separation and tubularization of the cecal plate from the exstrophied bladder halves and colostomy construction. The bladder was closed primarily and umbilical scar reconstructed and used for ureteral and cistostomy drainage. A urethral catheter was used to guide bladder neck tubularization. A final epispadic penis was obtained and planned for further repair in a second step. Results The patient had an initial uneventful postoperative course and immediate outcome was excellent. The bladder healed nicely but patient presented with abdominal distension in the 5th day of postoperative setting requiring parenteral nutrition. The distal colon persisted with lower diameter although non obstructive, but causing difficulty for fecal progression. Continuous colostomy dilatation and irrigation were required. Conclusions Approximating the bladder halves in the midline at birth and primary bladder closure is a viable option, intestinal transit may be a issue of concern in the early postoperative follow-up.
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spelling Cloacal Exstrophy: a complex disease Introduction Cloacal exstrophy is a rare occurrence with an incidence of 1:200,000 to 1:400,000 live births. It represents one of the most challenging reconstructive endeavors faced by pediatric surgeons and urologists. Aside from the genitourinary defects, there are other associated anomalies of the gastrointestinal, musculoskeletal and neurological systems that require a multidisciplinary approach when counseling anxious parents. Material and Methods We present a video of a patient with cloacal exstrophy treated with 21 days of life. Surgery consisted of separation and tubularization of the cecal plate from the exstrophied bladder halves and colostomy construction. The bladder was closed primarily and umbilical scar reconstructed and used for ureteral and cistostomy drainage. A urethral catheter was used to guide bladder neck tubularization. A final epispadic penis was obtained and planned for further repair in a second step. Results The patient had an initial uneventful postoperative course and immediate outcome was excellent. The bladder healed nicely but patient presented with abdominal distension in the 5th day of postoperative setting requiring parenteral nutrition. The distal colon persisted with lower diameter although non obstructive, but causing difficulty for fecal progression. Continuous colostomy dilatation and irrigation were required. Conclusions Approximating the bladder halves in the midline at birth and primary bladder closure is a viable option, intestinal transit may be a issue of concern in the early postoperative follow-up. Sociedade Brasileira de Urologia2013-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382013000600897International braz j urol v.39 n.6 2013reponame:International Braz J Urol (Online)instname:Sociedade Brasileira de Urologia (SBU)instacron:SBU10.1590/S1677-5538.IBJU.2013.06.19info:eu-repo/semantics/openAccessMacedo Jr,AntonioRondon,AtilaFrank,RicardoBacelar,HerickLeslie,BrunoOttoni,SergioGarrone,GilmarLiguori,RibertoOrtiz,Valdemareng2014-01-28T00:00:00Zoai:scielo:S1677-55382013000600897Revistahttp://www.brazjurol.com.br/ONGhttps://old.scielo.br/oai/scielo-oai.php||brazjurol@brazjurol.com.br1677-61191677-5538opendoar:2014-01-28T00:00International Braz J Urol (Online) - Sociedade Brasileira de Urologia (SBU)false
dc.title.none.fl_str_mv Cloacal Exstrophy: a complex disease
title Cloacal Exstrophy: a complex disease
spellingShingle Cloacal Exstrophy: a complex disease
Macedo Jr,Antonio
title_short Cloacal Exstrophy: a complex disease
title_full Cloacal Exstrophy: a complex disease
title_fullStr Cloacal Exstrophy: a complex disease
title_full_unstemmed Cloacal Exstrophy: a complex disease
title_sort Cloacal Exstrophy: a complex disease
author Macedo Jr,Antonio
author_facet Macedo Jr,Antonio
Rondon,Atila
Frank,Ricardo
Bacelar,Herick
Leslie,Bruno
Ottoni,Sergio
Garrone,Gilmar
Liguori,Riberto
Ortiz,Valdemar
author_role author
author2 Rondon,Atila
Frank,Ricardo
Bacelar,Herick
Leslie,Bruno
Ottoni,Sergio
Garrone,Gilmar
Liguori,Riberto
Ortiz,Valdemar
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Macedo Jr,Antonio
Rondon,Atila
Frank,Ricardo
Bacelar,Herick
Leslie,Bruno
Ottoni,Sergio
Garrone,Gilmar
Liguori,Riberto
Ortiz,Valdemar
description Introduction Cloacal exstrophy is a rare occurrence with an incidence of 1:200,000 to 1:400,000 live births. It represents one of the most challenging reconstructive endeavors faced by pediatric surgeons and urologists. Aside from the genitourinary defects, there are other associated anomalies of the gastrointestinal, musculoskeletal and neurological systems that require a multidisciplinary approach when counseling anxious parents. Material and Methods We present a video of a patient with cloacal exstrophy treated with 21 days of life. Surgery consisted of separation and tubularization of the cecal plate from the exstrophied bladder halves and colostomy construction. The bladder was closed primarily and umbilical scar reconstructed and used for ureteral and cistostomy drainage. A urethral catheter was used to guide bladder neck tubularization. A final epispadic penis was obtained and planned for further repair in a second step. Results The patient had an initial uneventful postoperative course and immediate outcome was excellent. The bladder healed nicely but patient presented with abdominal distension in the 5th day of postoperative setting requiring parenteral nutrition. The distal colon persisted with lower diameter although non obstructive, but causing difficulty for fecal progression. Continuous colostomy dilatation and irrigation were required. Conclusions Approximating the bladder halves in the midline at birth and primary bladder closure is a viable option, intestinal transit may be a issue of concern in the early postoperative follow-up.
publishDate 2013
dc.date.none.fl_str_mv 2013-12-01
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dc.language.iso.fl_str_mv eng
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Urologia
publisher.none.fl_str_mv Sociedade Brasileira de Urologia
dc.source.none.fl_str_mv International braz j urol v.39 n.6 2013
reponame:International Braz J Urol (Online)
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