CORRECTION OF BLADDER EXSTROPHY IN ADOLESCENT: 2 CASE REPORT

Introduction: bladder exstrophy is characterized by an incomplete development of anterior portion of bladder, urethra, abdominal wall and a median separation of pubic symphysis. We describe 2 clinical cases in adolescent treated with different surgical approach. Materials and Methods: two patients, one male and one female, respectively, 10 and 14 years old. Both cases had relapse: the bladder plate was performed in female when she was 2 years and in male when he was 6 years old. The male showed bladder exstrophy with epispadias; the female showed bifido clitoris, absence of minora labia with a small vaginal orifice. In both patients ano-rectal manometric and barium enema had normal parameters. The x-Ray basin showed diastasis of pubic bones, respectively, 7.5 cm in male and 10 cm in female. The male had closure of bladder and abdominal wall with transformation of epispadias to peno-scrotal hypospadias. The female had rectal reservoir (about 250cc), with amputation of the rectum with Hartmann’s method and recanalization with Duhamel’s method, anastomosis uretero rectal and vaginoplasty. Results: clinical and laboratory follow-up to date is 6 months. The female holds the urine about 2-3 hours during the day; in the night losses are not reported; the male shows dehiscence of abdominal and vesical wall with suprapubic fistula and loss of urine. The urethral peno-scrotal meatus appears patent. Conclusions: our experience, although limited in the number of cases and in the time of observation, is in agreement with the literature: we can say that the correction of bladder exstrophy in adolescents might be a urinary diversion with creation of rectal reservoir, useful for age of the patients and postoperative management. It is always necessary an adequate follow-up to check any complications.