Bladder eversion closure

Bladder valgus closure for surgical treatment of bladder valgus. Bladder valgus due to anterior wall defect of the bladder, urine overflow, the posterior wall mucosa exposed, prone to serious urinary tract infection, and often combined with other congenital malformations. Therefore, most died in infancy. According to the degree of bladder valgus, it can be divided into 4 types: 1 light type: bladder sphincter valgus with mild upper urethral fissure. 2 medium: the bladder neck and the triangle area are turned out, and the ureteral orifice is exposed. 3 is more severe: the posterior wall of the bladder is exposed, except for the urethral malformation, rectus abdominis and muscle sheath defects are more obvious, accompanied by pubic symphysis separation. 4 severe type: the bladder wall is turned over, accompanied by complete urethral fissure, abdominal wall and pubic symphysis extensive defect, can be combined with hip dislocation, inguinal hernia, umbilical bulging, spina bifida, anal atresia or intestinal malformation. The main treatment methods for bladder valgus are: 1 newborn, can be closed for 72 hours without osteotomy. After 48 hours, bilateral osteotomy is required. After osteotomy, you can use a simple sling to pull to 3 years old, and then do external fixation or closure after 3 years of age. Testosterone can be used with caution for children who are 2 years old and over. 312 to 18 months to do upper urethral fissure repair (Phase I). 4 Annual upper urinary tract (ultrasound) and bladder volume (cytoscopic). 5 bladder neck reconstruction with or without enteroplasty. 6 The bladder is emptied by pressing or intermittent catheterization. Treatment of diseases: bladder valgus Indication Newborns, the bladder closure can be performed without osteotomy within 48 hours of birth, and bilateral osteotomy should be performed after 48 hours, and external fixation or closure after 3 years of age. Preoperative preparation 1. The transfer of newborn babies from the hospital to the pediatric urology may be delayed for more than 48 hours due to various reasons. It is difficult to make the pelvic ring closure. It is necessary to explain to the family that osteotomy may be needed. 2. Ultrasound examination and intravenous pyelography before reconstruction surgery to exclude upper urinary tract abnormalities. 3. Antibiotics were applied 1 day before surgery. Surgical procedure Skin incision Trim and ligature the umbilicus, and retain the ligature line, and start doing all the mouth on the midline umbilicus. The deep incision was pressed with hot saline gauze to stop bleeding. 2. Free bladder The umbilical artery was used for induction, and the blunt dissection was performed on both sides of the anterior rectum and the posterior wall of the bladder. The ureter (the urethral catheter) was released downward to the bladder neck surface. 3. Free valgus bladder surrounding flap A finger is inserted behind the abdominal wall to complete the incision of the flap, and the wound is heat-sealed with hot saline gauze to stop bleeding. Keep the flaps around the valgus. Cut and separate the urethral disk, distal to fine. The interpubic tissue that fuses with the bladder neck is clearly visible at this time, which is an important sign. 4. Anatomical posterior ureth Free sputum and prostate under the corpus cavernosum, in order to retreat into the pelvis. 5. Urethral formation The valgus surrounding flap is used as a bridge connecting the urethral defect and building the urethra, so that the bladder and prostate fall into the pelvic cavity, and the bladder and prostate become organs in the pelvic cavity. Intermittent sutures with 6-0 synthetic absorbable sutures. 6. Close the bladder A side hole was placed with a soft silicone catheter No. 10, and the side hole of the catheter was placed in the closed bladder cavity and fixed with a gut. Fresh muscle tissue was trimmed at the edge of the bladder and the bladder was closed with a 3-0 synthetic absorbable suture interrupted suture. 7. Close the urethra The bladder neck region and the valgus surrounding flap were sutured into a tubular shape using a 5-0 synthetic absorbable suture. 8. Cut the interpubic tissue and wrap around the fixed urethra The tissue between the pubic bones is loosened from behind the pubic bone and surrounds the urethra. It is used to support the skin tube sutured by the flaps around the valgus and becomes the boundary between the abdominal cavity and the perineum. Due to the wide separation of the pubis, it is sometimes quite difficult to satisfy the purpose of embedding in this period. In many cases, it must be closed with the abdominal wall. 9. The pubic bone is fixed and fixed The pubis is made with 3-needle tension suture. The vignette shows a suture method that prevents the suture from cutting the urethra backwards, applying a 7-0 thick line or a 1-0 synthetic non-invasive suture to draw the pubis and ligature. 10. Umbilical angioplasty and closure of the wound The umbilicus is displaced to the tip of the abdominal incision. The closure of the abdominal incision begins with the rectus abdominis and is sutured layer by layer, from top to bottom, making the suture easy to complete. Vertical sutures were sutured with thick silk or 2-0 synthetic non-invasive sutures. The assistant helps to pressurize the pelvis toward the center, and the hip inward rotation helps to completely close the pubis. The skin is subcutaneously divided into two layers. complication Urinary fistula Urinary fistula is most likely to occur in the junction of the bladder and urethra. Small urinations sometimes heal themselves. Postoperative urine should be circulated to prevent infection of the incision. 2. Incision splitting Reduce suture, avoid cough, constipation and bloating after surgery.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.