The short-term disadvantageous of tension-suture and spica cast application in exstrophy-epispadias complex reconstruction: a case report

Ida Bagus Putra Pramana; Anak Agung Gde Oka; Gede Wirya Kusuma Duarsa; Kadek Budi Santosa; I Wayan Yudiana; Pande Made Wisnu Tirtayasa

doi:10.15562/ism.v10i3.605

The short-term disadvantageous of tension-suture and spica cast application in exstrophy-epispadias complex reconstruction: a case report

Ida Bagus Putra Pramana ,

Anak Agung Gde Oka ,

Gede Wirya Kusuma Duarsa ,

Kadek Budi Santosa ,

I Wayan Yudiana ,

Pande Made Wisnu Tirtayasa ,

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DOI: https://doi.org/10.15562/ism.v10i3.605 |
Published: 2019-12-01

Abstract

Background: Exstrophy-epispadias complex (EEC) represents a spectrum of genitourinary malformations and associated with another congenital anomaly. EEC is a rare congenital disability. EEC affects the genitourinary system, anterior abdominal wall, musculoskeletal system, spine and anus. The surgical outcome has a lot of potential complications in patient with EEC. The decision to first approach is important for the next step. Herein, we reported a case of EEC with several anomalies.

Case Description: A new-born male was born with section cesarean at 38 weeks of gestation from 34-year-old mother, and this is from the second pregnancy. The weight was 3300 grams, and the height was 48 centimetres. There was an abdominal wall defect with an exposed evaginated bladder plate with urine draining from the defect. A complete dorsally opened urethral plate was seen from the bladder neck down to the glandular grove. The patient was diagnosed with Exstrophy-epispadias complex (EEC). A 2 stage repair was conducted in this patient. After 10 days post-operation, the wound became dehiscence and got sepsis postoperatively as well as lead to die in the day 20.

Conclusion: Wound dehiscence following reconstruction is very critical inpatient with EEC. Tension suture and spica cast application can be disadvantageous inpatient with EEC.

References

Ebert AK, Reutter H, Ludwig M, RÃ¶sch WH. The exstrophy-epispadias complex. Orphanet J Rare Dis. 2009;4:23.
Nelson CP, Dunn RL, Wei JT. Contemporary epidemiology of bladder exstrophy in the United States. J Urol. 2005;173(5):1728â€“1731
Mahfuz I, Darling T, Wilkins S, White S, Cheng W. New insights into the pathogenesis of bladder exstrophy-epispadias complex. J Pediatr Urol. 2013 Dec;9(6 Pt B):996-1005.
Oesterling JE, Jeffs RD. The importance of a successful initial bladder closure in the surgical management of classical bladder exstrophy: analysis of 144 patients treated at the Johns Hopkins Hospital between 1975 and 1985. J Urol 1987; 137:258e62
Inouye BM, Tourchi A, Di Carlo HN, Young EE, Gearhart JP. Modern management of the exstrophy-epispadias complex. Surg Res Pract. 2014;2014:587064.
Arlen AM, Cooper CS, Morcuende J, Austin JC. Safety and efficacy of spica casts for immobilization following initial bladder closure in classic bladder exstrophy. J Pediatr Urol. 2011;7(4):456-9.
Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105(7):2583-6
Dodson JL, Surer I, Baker LA, Jeffs RD, Gearhart JP. The newborn exstrophy bladder inadequate for primary closure: evaluation, management and outcome. J Urol. 2001;165(5):1656-9.
Jelsig AM, Qvist N, Brusgaard K, Nielsen CB, Hansen TP, Ousager LB. Hamartomatous polyposis syndromes: a review. Orphanet J Rare Dis. 2014;9:101.
Stringer MD, Duffy PG, Ransley PG. Inguinal hernias associated with bladder exstrophy. Br J Urol. 1994;73(3):308-9.
Connolly JA, Peppas DS, Jeffs RD, Gearhart JP. Prevalence and repair of inguinal hernias in children with bladder exstrophy. J Urol. 1995;154(5):1900-1.
Stec AA. Embryology and bony and pelvic floor anatomy in the bladder exstrophy-epispadias complex. Semin Pediatr Surg. 2011;20(2):66â€“70
Shnorhavorian M, Song K, Zamilpa I, Wiater B, Mitchell MM, Grady RW. Spica casting compared to Bryant's traction after complete primary repair of exstrophy: safe and effective in a longitudinal cohort study. J Urol. 2010 Aug;184(2):669-73.
Meldrum KK, Baird AD, Gearhart JP. Pelvic and extremity immobilization after bladder exstrophy closure: complications and impact on success. Urology. 2003;62(6):1109-13.

[1] Ebert AK, Reutter H, Ludwig M, RÃ¶sch WH. The exstrophy-epispadias complex. Orphanet J Rare Dis. 2009;4:23.

[2] Nelson CP, Dunn RL, Wei JT. Contemporary epidemiology of bladder exstrophy in the United States. J Urol. 2005;173(5):1728â€“1731

[3] Mahfuz I, Darling T, Wilkins S, White S, Cheng W. New insights into the pathogenesis of bladder exstrophy-epispadias complex. J Pediatr Urol. 2013 Dec;9(6 Pt B):996-1005.

[4] Oesterling JE, Jeffs RD. The importance of a successful initial bladder closure in the surgical management of classical bladder exstrophy: analysis of 144 patients treated at the Johns Hopkins Hospital between 1975 and 1985. J Urol 1987; 137:258e62

[5] Inouye BM, Tourchi A, Di Carlo HN, Young EE, Gearhart JP. Modern management of the exstrophy-epispadias complex. Surg Res Pract. 2014;2014:587064.

[6] Arlen AM, Cooper CS, Morcuende J, Austin JC. Safety and efficacy of spica casts for immobilization following initial bladder closure in classic bladder exstrophy. J Pediatr Urol. 2011;7(4):456-9.

[7] Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105(7):2583-6

[8] Dodson JL, Surer I, Baker LA, Jeffs RD, Gearhart JP. The newborn exstrophy bladder inadequate for primary closure: evaluation, management and outcome. J Urol. 2001;165(5):1656-9.

[9] Jelsig AM, Qvist N, Brusgaard K, Nielsen CB, Hansen TP, Ousager LB. Hamartomatous polyposis syndromes: a review. Orphanet J Rare Dis. 2014;9:101.

[10] Stringer MD, Duffy PG, Ransley PG. Inguinal hernias associated with bladder exstrophy. Br J Urol. 1994;73(3):308-9.

[11] Connolly JA, Peppas DS, Jeffs RD, Gearhart JP. Prevalence and repair of inguinal hernias in children with bladder exstrophy. J Urol. 1995;154(5):1900-1.

[12] Stec AA. Embryology and bony and pelvic floor anatomy in the bladder exstrophy-epispadias complex. Semin Pediatr Surg. 2011;20(2):66â€“70

[13] Shnorhavorian M, Song K, Zamilpa I, Wiater B, Mitchell MM, Grady RW. Spica casting compared to Bryant's traction after complete primary repair of exstrophy: safe and effective in a longitudinal cohort study. J Urol. 2010 Aug;184(2):669-73.

[14] Meldrum KK, Baird AD, Gearhart JP. Pelvic and extremity immobilization after bladder exstrophy closure: complications and impact on success. Urology. 2003;62(6):1109-13.

The short-term disadvantageous of tension-suture and spica cast application in exstrophy-epispadias complex reconstruction: a case report

Abstract

References

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