Ebook: The Exstrophy—Epispadias Complex: Research Concepts and Clinical Applications

The undertaking of the treatment of an infant born with bladder exstrophy is one of the most weighty responsibilities that can fall upon the shoulders of the reconstructive sur­ geon. The modern treatment of a child born with bladder exstrophy began in the mid- 1970's with the widespread application of staged reconstruction. This approach has consistently yielded very good results in several series. However, as in all serious congeni­ tal birth defects, there is certainly room for advancement. Issues such as the routine use of osteotomy, timing and type of epispadias repair, combining bladder closure with epispadias repair, the approach to the small bladder, and the management of a failed exstrophy still remain. This National Institute of Health/Na­ tional Kidney Foundation/Johns Hopkins-sponsored seminar was an attempt to bring ex­ perts in the field of pediatric orthopedic surgery, pediatric urology, pediatric surgery, adult urology, and basic science together to share their experiences in an attempt to foster new clinical and basic science research communications between the participants. If these col­ laborations result, then this first international meeting will have been successful. The editors would like to thank all of the contributors for their timely and complete submissions. John P. Gearhart, M.D. Ranjiv Mathews, M.D. vii CONTENTS 1. The Embryology and Epidemiology of Bladder Exstrophy ................. .

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This book contains the most up-to-date scientific information on the anatomy, physiology, and pathophysiology of the bladder muscle, nerves, and collagen in the patient with bladder exstrophy. In addition, this book covers the most modern surgical treatment of the infant born with bladder exstrophy and those who fail initial reconstruction. Chapters are contributed by major children's centers throughout the world. The aims of this book are to familiarize both the resident and the experienced practitioner with the most modern methods for the treatment for bladder exstrophy and epispadias. This book deals with the function, innervation, and pathophysiology of the bladder muscle in the patient born with bladder exstrophy. New concepts from leading laboratories around the world regarding the function of the bladder are discussed. In addition, experts offer their advice, expertise, and thoughts concerning the management of the patient born with bladder exstrophy. This book is intended for researchers who are interested in both the innervation, structure and function of bladder muscle and for pediatricians, pediatric surgeons, pediatric orthopedic surgeons, and both adult and pediatric urologists who deal with patients from birth until adult life who are born with bladder exstrophy. This is the first book to deal specifically with the basic science of bladder exstrophy and the clinical management of the bladder exstrophy-epispadias complex.

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This book contains the most up-to-date scientific information on the anatomy, physiology, and pathophysiology of the bladder muscle, nerves, and collagen in the patient with bladder exstrophy. In addition, this book covers the most modern surgical treatment of the infant born with bladder exstrophy and those who fail initial reconstruction. Chapters are contributed by major children's centers throughout the world. The aims of this book are to familiarize both the resident and the experienced practitioner with the most modern methods for the treatment for bladder exstrophy and epispadias. This book deals with the function, innervation, and pathophysiology of the bladder muscle in the patient born with bladder exstrophy. New concepts from leading laboratories around the world regarding the function of the bladder are discussed. In addition, experts offer their advice, expertise, and thoughts concerning the management of the patient born with bladder exstrophy. This book is intended for researchers who are interested in both the innervation, structure and function of bladder muscle and for pediatricians, pediatric surgeons, pediatric orthopedic surgeons, and both adult and pediatric urologists who deal with patients from birth until adult life who are born with bladder exstrophy. This is the first book to deal specifically with the basic science of bladder exstrophy and the clinical management of the bladder exstrophy-epispadias complex.
Content:
Front Matter....Pages i-xi
The Embryology and Epidemiology of Bladder Exstrophy....Pages 1-4
Prenatal Diagnosis of Bladder and Cloacal Exstrophy and Related Conditions....Pages 5-8
Anatomy and Biomechanics of the Pelvis in Exstrophy....Pages 9-15
Detrusor Morphology and Innervation in Bladder Exstrophy....Pages 17-23
The Response of the Bladder Smooth Muscle to Increased Bladder Neck Resistance....Pages 25-31
Muscarinic Cholinergic Receptors in Bladder Exstrophy....Pages 33-39
A Quantitative Histological Analysis of the Bladder in Classical Bladder Exstrophy in Various Stages of Reconstruction Utilizing Color Morphometry....Pages 41-47
Analysis of Smooth Muscle and Collagen Subtypes in the Normal Newborn and Bladder Exstrophy Patient....Pages 49-55
A Large Animal Model of Bladder Exstrophy....Pages 57-61
Tissue Engineering Techniques for Closure of Bladder Exstrophy....Pages 63-64
Surgical Principles in the Primary Closure of Bladder Exstrophy....Pages 65-67
Anterior and Posterior Innominate Osteotomy in Exstrophy Repair....Pages 69-75
Bladder Exstrophy Closure without Osteotomy in Philadelphia....Pages 77-82
Bilateral Anterior Pubic Osteotomy in Bladder Exstrophy Closure....Pages 83-91
The Failed Exstrophy Closure....Pages 93-96
Applications of Ureterosigmoidostomy in Bladder Exstrophy....Pages 97-103
Cystoplasty in Bladder Exstrophy....Pages 105-110
Bladder Exstrophy....Pages 111-115
Penile Length in Adulthood after Exstrophy Reconstruction....Pages 117-125
Complete Penile Disassembly for Epispadias Repair....Pages 127-131
The Cantwell-Ransley Epispadias Repair In Exstrophy/Epispadias....Pages 133-138
The Impact of Urodynamics on Surgery for Incontinence in Children with Exstrophy....Pages 139-140
The Use of Sub-Mucosal Collagen in the Small Bladder Associated with Bladder Exstrophy....Pages 141-147
Review of Long-Term Results of Staged Functional Reconstruction and Bladder Neck Plasty in Bladder Exstrophy Patients Followed from Birth at the Johns Hopkins Hospital....Pages 149-163
Psychological Aspects of Bladder Exstrophy....Pages 165-167
The Outcome of Patients with Classic Bladder Exstrophy in Adult Life....Pages 169-173
Long Term Results of Bladder Exstrophy....Pages 175-183
Long Term Results of Bladder Exstrophy....Pages 185-191
Semen Analysis and Transrectal Ultrasound Findings in Men with Bladder Exstrophy....Pages 193-197
Anatomy of Cloacal Exstrophy....Pages 199-206
Current Urologic Management of Cloacal Exstrophy....Pages 207-215
Indications and Types of Bladder Augmentation in Cloacal Exstrophy....Pages 217-219
Cloacal Exstrophy....Pages 221-236
Abstracts....Pages 237-250
Back Matter....Pages 251-252

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This book contains the most up-to-date scientific information on the anatomy, physiology, and pathophysiology of the bladder muscle, nerves, and collagen in the patient with bladder exstrophy. In addition, this book covers the most modern surgical treatment of the infant born with bladder exstrophy and those who fail initial reconstruction. Chapters are contributed by major children's centers throughout the world. The aims of this book are to familiarize both the resident and the experienced practitioner with the most modern methods for the treatment for bladder exstrophy and epispadias. This book deals with the function, innervation, and pathophysiology of the bladder muscle in the patient born with bladder exstrophy. New concepts from leading laboratories around the world regarding the function of the bladder are discussed. In addition, experts offer their advice, expertise, and thoughts concerning the management of the patient born with bladder exstrophy. This book is intended for researchers who are interested in both the innervation, structure and function of bladder muscle and for pediatricians, pediatric surgeons, pediatric orthopedic surgeons, and both adult and pediatric urologists who deal with patients from birth until adult life who are born with bladder exstrophy. This is the first book to deal specifically with the basic science of bladder exstrophy and the clinical management of the bladder exstrophy-epispadias complex.
Content:
Front Matter....Pages i-xi
The Embryology and Epidemiology of Bladder Exstrophy....Pages 1-4
Prenatal Diagnosis of Bladder and Cloacal Exstrophy and Related Conditions....Pages 5-8
Anatomy and Biomechanics of the Pelvis in Exstrophy....Pages 9-15
Detrusor Morphology and Innervation in Bladder Exstrophy....Pages 17-23
The Response of the Bladder Smooth Muscle to Increased Bladder Neck Resistance....Pages 25-31
Muscarinic Cholinergic Receptors in Bladder Exstrophy....Pages 33-39
A Quantitative Histological Analysis of the Bladder in Classical Bladder Exstrophy in Various Stages of Reconstruction Utilizing Color Morphometry....Pages 41-47
Analysis of Smooth Muscle and Collagen Subtypes in the Normal Newborn and Bladder Exstrophy Patient....Pages 49-55
A Large Animal Model of Bladder Exstrophy....Pages 57-61
Tissue Engineering Techniques for Closure of Bladder Exstrophy....Pages 63-64
Surgical Principles in the Primary Closure of Bladder Exstrophy....Pages 65-67
Anterior and Posterior Innominate Osteotomy in Exstrophy Repair....Pages 69-75
Bladder Exstrophy Closure without Osteotomy in Philadelphia....Pages 77-82
Bilateral Anterior Pubic Osteotomy in Bladder Exstrophy Closure....Pages 83-91
The Failed Exstrophy Closure....Pages 93-96
Applications of Ureterosigmoidostomy in Bladder Exstrophy....Pages 97-103
Cystoplasty in Bladder Exstrophy....Pages 105-110
Bladder Exstrophy....Pages 111-115
Penile Length in Adulthood after Exstrophy Reconstruction....Pages 117-125
Complete Penile Disassembly for Epispadias Repair....Pages 127-131
The Cantwell-Ransley Epispadias Repair In Exstrophy/Epispadias....Pages 133-138
The Impact of Urodynamics on Surgery for Incontinence in Children with Exstrophy....Pages 139-140
The Use of Sub-Mucosal Collagen in the Small Bladder Associated with Bladder Exstrophy....Pages 141-147
Review of Long-Term Results of Staged Functional Reconstruction and Bladder Neck Plasty in Bladder Exstrophy Patients Followed from Birth at the Johns Hopkins Hospital....Pages 149-163
Psychological Aspects of Bladder Exstrophy....Pages 165-167
The Outcome of Patients with Classic Bladder Exstrophy in Adult Life....Pages 169-173
Long Term Results of Bladder Exstrophy....Pages 175-183
Long Term Results of Bladder Exstrophy....Pages 185-191
Semen Analysis and Transrectal Ultrasound Findings in Men with Bladder Exstrophy....Pages 193-197
Anatomy of Cloacal Exstrophy....Pages 199-206
Current Urologic Management of Cloacal Exstrophy....Pages 207-215
Indications and Types of Bladder Augmentation in Cloacal Exstrophy....Pages 217-219
Cloacal Exstrophy....Pages 221-236
Abstracts....Pages 237-250
Back Matter....Pages 251-252
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