Name of the Procedure:

Closure, exstrophy of bladder
(Bladder Closure Surgery, Exstrophy Repair)

Summary

Bladder exstrophy closure is a surgical procedure to correct bladder exstrophy, a congenital condition where the bladder is exposed outside the abdomen. The surgery involves repositioning and reconstructing the bladder and surrounding tissues inside the pelvis.

Purpose

The primary purpose is to treat bladder exstrophy, a condition that leads to issues with urinary control, risk of infections, and complications in kidney function. The procedure aims to reconstruct a functional bladder, allowing normal urination and reducing the risk of infections and other complications.

Indications

• Bladder exstrophy diagnosed in newborns or infants.
• Inability to control urination due to bladder exposure.
• Risk of recurrent urinary tract infections.
• Potential kidney damage from untreated bladder exstrophy.

Preparation

• Fasting for a specific period before surgery (typically overnight).
• Adjustments or cessation of certain medications as advised by the healthcare team.
• Diagnostic imaging and tests such as ultrasound or MRI to assess bladder and surrounding structures.

Procedure Description

1. Anesthesia: The patient receives general anesthesia for a pain-free and unconscious state during the surgery.
2. Incision: An incision is made in the lower abdomen to access the exposed bladder and surrounding tissues.
3. Repositioning: The bladder is carefully repositioned inside the pelvis.
4. Reconstruction: Surgeons reconstruct the bladder wall and close the abdominal muscles and skin.
5. Urinary diversion: A temporary urinary catheter may be placed to aid in healing and ensure proper urine flow.

Duration

Typically, the procedure lasts between 4 to 6 hours, depending on the complexity of the exstrophy and any additional reconstructive needs.

Setting

This procedure is performed in a hospital operating room, requiring specialized surgical equipment and an experienced surgical team.

Personnel

• Pediatric urologist or specialized surgeon.
• Anesthesiologist.
• Surgical nurses.
• Operating room technicians.
• Post-operative care team.

Risks and Complications

• Infection at the surgical site.
• Bleeding or blood clots.
• Difficulty with urination or urinary retention.
• Complications associated with anesthesia.
• Need for additional surgeries or interventions.

Benefits

• Improved urinary control and function.
• Decreased risk of urinary tract infections.
• Preservation of kidney function.
• Enhanced quality of life and ease of social interactions.

Recovery

• Hospital stay of about 1-2 weeks post-surgery.
• Pain management with medications.
• Maintenance of urinary catheter for several weeks to ensure proper healing.
• Follow-up appointments for monitoring healing and bladder function.
• Restriction on strenuous activities for several months.

Alternatives

• Non-surgical management: Use of catheters and protective barriers, though not typically effective long-term.
• Delayed surgery: Waiting until the child is older, but this may lead to increased complications.

Patient Experience

The patient will be under general anesthesia during the procedure, so they will not feel pain during surgery. Post-operative discomfort will be managed with pain relief measures. Full recovery and return to normal activities may take several months, during which time the patient will need to follow medical guidance carefully to ensure proper healing.