Where Single Stage Surgery In Newborns With Bladder Extrophy Epispadias Complex Is Done
THE ONLY CENTRE IN NORTH KARNATAKA WHERE SINGLE STAGE SURGERY IN NEWBORNS WITH BLADDER EXTROPHY EPISPADIAS COMPLEX IS DONE
Bladder exstrophy epispadias complex (BEEC) is a devastating congenital abnormality that occurs in mother’s womb in early weeks of pregnancy where the skin and other tissues are not formed over the lower abdominal & anterior wall of bladder, where the bladder remains open and exposed on the outside of the lower abdomen and also has epispadias where the penile urethra does not form properly.
Exstrophy means “eversion of a part” or “turning of a part inside out”. Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the tissues above bladder do not form properly, so the bladder is open and exposed to the exterior. All the children with bladder exstrophy have epispadias also, along with short stubby penis (males), bifid clitoris (females), pubic diastases, and divarication of recti in both sexes. Other problems include presence of inguinal hernias, anteriorly placed anus in both sexes with undescended testes in males. The bladder capacity is usually small, ureter openings exposed and with abnormality of pelvic bones. The worse thing in these children is continuous dribbling of urine and foul smelling ammoniacal odour leading to social issues, inability to mix with peers and attend school and lead a normal childhood.
Is Bladder exstrophy (BEEC) a common condition ? The answer is No
BEEC only occurs in one in every 40,000 live births, affecting two and half times more commonly the males than female children which is about 1 in 1,00,000 live births. Rarity means the management guidelines or protocols are not existing or unclear leading to chaos in choosing a particular surgical technique and difficulty in giving consistently good or acceptable results.
Can this complex disease be corrected in single operation? The answer is yes
Dr Santosh B Kurbet, professor & senior Pediatric Surgical consultant choose single stage surgery to reduce economic burden on the family, single hospital admission in older children in his earlier days and extended to newborn repairs which lead to immediate improved maternal bonding with the baby, it also leads to bladder cycling, optimizes capacity & compliance, may obviate need for augmentation, which provided rich dividends in the form of results in these affected babies in his earlier cases and hence he applied to newborns.
Is it possible to give results both good functional and cosmetic results in single go ? The Answer is yes
Dr Kurbet, continued the surgeries in children as well as in newborns which took 8 hours initially and now he does this in 4-5 hours in a single stage. With consistency in functional & cosmetic results. He also went to present this at International forum & conferences, had publications, coined a new term “Social Continence” for this child’s ability to hold urine so that a child can attend his school hours, play along peers without wetting his under garments which was a huge gain in the management of these children.
Dr Santosh B. Kurbet
Professor & Head, Dept of Paediatric Surgery