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Paediatric Surgery
Bladder Exstrophy Epispadias and Cloacal Exstrophy
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
5 sections · 84 slides
The Exstrophy-Epispadias Complex
What links these defects, and why they matter
- What this deck will teach you
- What is the exstrophy-epispadias complex (EEC)?
- The spectrum runs from mild to severe
- Three members of one family
- Why group them together?
- How rare is each condition?
- Incidence in numbers
- Outcome depends heavily on where the baby is born
- What causes it? Genetics gives clues, not answers
- Normal development of the lower midline
- Cloacal rupture theory: a wall that breaks too early
- Two theories for how the wall fails
Bladder Exstrophy
The commonest form: from delivery room to a continent bladder
- Spotting it before birth
- Antenatal scan signs and how often they appear
- How the newborn looks
- Male bladder exstrophy at birth
- The male genitalia in bladder exstrophy
- Female bladder exstrophy at birth
- The female genitalia in bladder exstrophy
- Other features to expect at birth
- First hours: protect the baby, do not rush surgery
- Work-up before closure
- Neonatal closure: the goal
- Neonatal closure: freeing and closing the bladder
- Neonatal closure: rebuilding the pelvic ring
- After surgery
- The feared early complication: wound dehiscence
- Why reflux is universal in exstrophy
- Pelvic osteotomy: when the bones need cutting
- Complete primary reconstruction (CPRE)
- A single-stage philosophy has many forms
- Why more surgery is usually needed
- Continence route 1: staged reconstruction
- Continence route 2: the modern staged repair
- The Kelly procedure: radical soft-tissue mobilization
- Kelly procedure: rebuilding outlet and penis
- The Kelly procedure in girls
- A simple, practical continence grading
- Kelly operation continence outcomes
- Reading the Kelly outcome data
- What actually creates continence
- Continence outcomes from CPRE alone are sobering
- Outcomes from modern staged repair vary by selection
- Protecting the kidneys long-term
- Bladder stones after reconstruction
- Male sexual function and fertility
- Female sexual function and fertility
- The long shadow: malignancy risk
- Quality of life tracks continence
Cloacal Exstrophy
The most severe survivable anomaly in pediatric urology
- Cloacal exstrophy in a male newborn
- Why cloacal exstrophy is the severest survivable defect
- The anatomy at birth
- Anomalies that commonly travel with cloacal exstrophy
- Early management: stabilize, feed, and wait
- Gender: a changed approach
- A three-stage surgical strategy
- Stage 1: closing the exstrophy (bones and bowel)
- Stage 1: bladder, genitalia, and the abdominal wall
- Stage 2: penile surgery in boys
- Stage 3: continent reconstruction
- Great Ormond Street cloacal exstrophy outcomes
- Interpreting the cloacal exstrophy outcomes
Primary Epispadias
The mildest-looking member that still threatens continence
- Grades of male epispadias
- Male epispadias: what you see
- Female epispadias
- Female epispadias: easy to miss
- Investigation: cystoscopy tells the truth
- Surgery in boys with good continence indicators
- Surgery in boys with poor continence indicators
- Surgery in girls
Key Messages
Pulling the spectrum together
- Conclusion: one theme, very different problems
- The future is specialization
- Three take-home messages
- References (1/4)
- References (2/4)
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- References (4/4)
- Pediatric Surgery and Pediatric Urology