ESPU Congress 2018 - Abstract Book

131 11–14 APRIL, 2018, HELSINKI, FINLAND S17: EXTROPHY-EPISPADIAS COMPLEX 1 Moderators: Ashraf Hafez (Egypt), Wolfgang Rösch (Germany) ESPU Meeting on Friday 13, April 2018, 14:24–15:02 14:24–14:27 S17-1 (PP) ★ ONE-STAGE COMBINED DELAYED BLADDER CLOSURE AND KELLY RADICAL SOFT-TISSUE MOBILISATION FOR BLADDER EXSTROPHY Sébastien FARAJ  1 , Sajid SULTAN  2 , Georges AUDRY  3 , Yves HELOURY  4 , Philip RANSLEY  2 and Marc-David LECLAIR  1 1) Hôpital Mère-Enfant, Chirurgie Infantile, Nantes, FRANCE - 2) Sindh Institute of Urology & Transplantation, Pediatric Urology, Karachi, PAKISTAN - 3) Hôpital Trousseau, Chirurgie Pédiatrique, Paris, FRANCE - 4) Royal Children Hospital, Pediatric Urology, Melbourne, AUSTRALIA PURPOSE The radical soft-tissue mobilisation (RSTM or Kelly repair) for bladder exstrophy (BE) has been so far reported as part of a two-stage strategy after successful neonatal closure. With the emerg- ing concept of delayed closure of BE, we investigated the feasibility of one-stage delayed bladder closure combined with RSTM in infants with classical BE. MATERIAL AND METHODS Prospective inclusion and follow-up of consecutive newborns with BE in an 18-month period (2016–2017). Repair was performed (ideally at the age of 3 months) by the same surgeon at 4 collaborating institutions. Technique included RSTM with ureteric reimplant, cervicoplasty, penile reconstruction, and bladder closure, without pelvic osteotomies. Midline closure was performed with transposition of rectus abdominis muscles whenever necessary. Postoperative immobilisation was maintained for 21 days. Postoperative follow-up was based on clinical examination and renal US at 1–3–6–12 months, and EUA+endoscopy at 4 and 12 months postoperatively. Main outcome criteria was postoperative bladder dehiscence at 3 months. Secondary outcome measures included urethrocutaneous fistula, stenosis, and UTIs. RESULTS 11 children (8 M/3F) were included in this study and underwent surgery at a median age of 15 weeks [2–32] for those with intentional delayed surgery (n=8) and 43 wks [14–104] for those presenting late (n=3). Median follow-up was 10 months [4–20]. No case of bladder dehiscence was observed after all cases reached the 3 months end-point. Three children presented postoperative urethro-cutaneous fistula, all of which closed spontaneously in 3–6 weeks. One boy presented symptomatic urethral stenosis (orchi-epididymitis and UTIs) suc- cessfully treated with 3 sessions of endoscopic balloon dilatation (follow-up of 11 months after the last session). No case of glans ischemia was observed. Minor skin dehiscence was successfully treated conservatively in 3 cases.