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• W1989403788 abstract "You have accessJournal of UrologyPediatrics1 Apr 2015V7-04 MULTI-INSTITUTIONAL BLADDER EXSTROPHY CONSORTIUM: COMPLETE PRIMARY REPAIR OF EXSTROPHY Joseph G. Borer, Evalynn Vasquez, Anthony J. Schaeffer, Douglas A. Canning, John V. Kryger, and Michael E. Mitchell Joseph G. BorerJoseph G. Borer More articles by this author , Evalynn VasquezEvalynn Vasquez More articles by this author , Anthony J. SchaefferAnthony J. Schaeffer More articles by this author , Douglas A. CanningDouglas A. Canning More articles by this author , John V. KrygerJohn V. Kryger More articles by this author , and Michael E. MitchellMichael E. Mitchell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1935AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For bladder exstrophy (BE) repair, gaining necessary surgical experience is challenging due to the rarity of BE. We created a multi-institutional collaboration for the purposes of sharing collective expertise, to efficiently maximize surgical proficiency, and to standardize surgical technique and subsequent care of complete primary repair of exstrophy (CPRE). Our objective is to demonstrate the surgical technique adopted by this collaboration. METHODS Boston Children's Hospital, Children's Hospital of Philadelphia and Children's Hospital of Wisconsin alternately served as host site for scheduled surgeries, with observation, commentary and critique by surgeons from the other sites. Technique was CPRE with bilateral iliac osteotomy performed at 1-3 months of age. Video recording was used for real-time observation both locally and remotely, teaching, future analysis, editing, and review. RESULTS From February 2013 through September 2014, CPRE was performed in 23 patients: 12 boys and 8 girls with classic bladder exstrophy; 1 boy and 2 girls with epispadias. Three surgical modifications were adopted by the group. The first concerned approach to the urethral plate dissection in the boy. The current approach uses a ventral dissection along the medial aspect of the corpora cavernosa using bipolar electrocautery. The second was the deliberate attempt to form a bladder neck in an effort to increase continence by elongating the urethra and creating a more acutely angled transition from proximal urethra to bladder neck into bladder. The third was made after urethral obstruction was noted in 3 girls. Preplacement of perineal and urethral meatus sutures prior to approximation of the pubis allowed optimal exposure of the tissue for accurate and precise suture placement. Complications in girls included 4 episodes of pyelonephritis, 3 urethral obstructions (1 resulted in bladder rupture and 2 required temporary clean intermittent catheterization), and 1 partial labial separation. Complications in boys included 3 urethrocutaneous fistula, 1 hypospadias, return to operating room for 1 suprapubic tube removal, and 1 spica cast change. All closures were successful without dehiscence. CONCLUSIONS We report the surgical method adopted by a multi-institutional collaboration. The increased volume of patients, expert opinions shared, and proficiency gained were immediate benefits observed. This effort increased the annual experience of each institution involved from 3 to 9-fold to ultimately benefit patient care. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e660 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph G. Borer More articles by this author Evalynn Vasquez More articles by this author Anthony J. Schaeffer More articles by this author Douglas A. Canning More articles by this author John V. Kryger More articles by this author Michael E. Mitchell More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ..." @default.
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• W1989403788 title "V7-04 MULTI-INSTITUTIONAL BLADDER EXSTROPHY CONSORTIUM: COMPLETE PRIMARY REPAIR OF EXSTROPHY" @default.
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