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John P. Gearhart - One of the best experts on this subject based on the ideXlab platform.
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Female Bladder Exstrophy Repair
DeckerMed Urology, 2019Co-Authors: Timothy S. Baumgartner, John P. GearhartAbstract:This chapter details the latest surgical advances and outcomes in the modern surgical management of female classic Bladder Exstrophy to include patient selection for closure, operative considerations, and outcomes. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This chapter also reviews the incidence, embryology, and anatomic considerations when approaching the treatment of the Exstrophy patient. This review contains 4 figures, and 36 references. Key Words: Bladder Exstrophy, congenital defect, embryology, epispadias, pelvic floor, reconstruction, sexual function, urinary continence
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Staged Male Bladder Exstrophy Repair
DeckerMed Urology, 2019Co-Authors: Timothy S. Baumgartner, John P. GearhartAbstract:This chapter details the latest surgical advances and outcomes in the modern surgical management of male classic Bladder Exstrophy to include patient selection for closure, operative considerations, newborn primary Bladder and posterior urethral closure, early epispadias repair, Bladder neck reconstruction with an antireflux procedure, and postoperative management. It highlights how to achieve the primary objectives of (1) a secure abdominal closure, (2) reconstruction of a functional and cosmetically acceptable penis, and (3) urinary continence with the preservation of renal function. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This review contains 3 figures, 5 tables, and 47 references. Key Words: Congenital defect, Bladder Exstrophy, Epispadias, Reconstruction, Urinary Continence, Magnetic Resonance Imaging, Pain management, Pelvic osteotomy
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Modern Management of Bladder Exstrophy Repair
Current urology reports, 2013Co-Authors: Brian M. Inouye, Eric Z. Massanyi, Heather N. Di Carlo, Bhavik B. Shah, John P. GearhartAbstract:The Exstrophy–epispadias complex is a rare congenital malformation of the genitourinary system, abdominal wall musculature, and pelvic bones. Historically, surgical outcomes in patients with classic Bladder Exstrophy, the most common presentation of the Exstrophy–epispadias complex, were poor. However, modern techniques have increased the success of achieving urinary continence, satisfactory cosmesis, and improved quality of life. Still, recent studies recognize complications that may occur during management of these patients. This review provides readers with an overview of the Exstrophy–epispadias complex, the modern management of Bladder Exstrophy, and potential surgical complications.
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Congenital Renal Anomalies in Patients With Classic Bladder Exstrophy
Urology, 2011Co-Authors: Andrew A. Stec, Nima Baradaran, John P. GearhartAbstract:Objective To determine the proportion and type of renal anomalies that occur in children born with classic Bladder Exstrophy. Material and Methods All patients in a database of 1044 patients with the Bladder Exstrophy-epispadias-cloacal Exstrophy complex were reviewed. Those with classic Bladder Exstrophy had their complete medical records reviewed and children with radiographic evidence of congenital renal anomalies were identified and characterized. Results A total of 674 patients were identified with classic Bladder Exstrophy, of whom 462 had renal ultrasounds at the authors' institution. In this population, 13/462 (2.8%) had concomitant renal anomalies. The most common malformation was a duplicated collecting system in 6 patients. Hypoplastic or absent kidneys were present in 3 patients, pelvic kidney in 2, ureteropelvic junction obstruction in 1, and multicystic dysplastic kidney in 1 patient. Conclusion Isolated renal anomalies occur at a rate of 2.8% in children born with classic Bladder Exstrophy. Although uncommon in this rare birth defect, anatomic understanding of the entire genitourinary system is critical for operative planning and long-term follow-up of patients with Bladder Exstrophy.
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A short history of Bladder Exstrophy
Seminars in pediatric surgery, 2011Co-Authors: Cenk Büyükünal, John P. GearhartAbstract:The first description of Bladder Exstrophy was noted on Assyrian tablets nearly 4000 years ago. Since then various papers has been published with an increasing rate. According to the available historical data, almost all operative techniques had been described during the last two centuries. We believe, the pioneers put a lot of work in this field and passed on their theoretic knowledge and surgical experience to the current era. Our duty is keep this treasure and add the benefits of recent new technological developments for the future care of our Bladder Exstrophy patients.
Joseph G. Borer - One of the best experts on this subject based on the ideXlab platform.
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combined cystometrography and electromyography of the external urethral sphincter following complete primary repair of Bladder Exstrophy
The Journal of Urology, 2014Co-Authors: Joseph G. Borer, Ilina Rosoklija, David A Diamond, Ruth Strakosha, Stuart B Bauer, Melanie Pennison, Shahram KhoshbinAbstract:Purpose: Concern in patients with Bladder Exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of Bladder Exstrophy. We determined whether complete primary repair of Bladder Exstrophy would adversely affect the innervation controlling Bladder and external urethral sphincter function.Materials and Methods: Complete primary repair of Bladder Exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding.Results: Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary re...
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Health Related Quality of Life in Patients with Bladder Exstrophy: A Call for Targeted Interventions
The Journal of Urology, 2014Co-Authors: Melanie Pennison, Lauren Mednick, Ilina Rosoklija, Rosemary Grant, D. A. Price, Lin Huang, Sonja I. Ziniel, Joseph G. BorerAbstract:Purpose: Research on health related quality of life in patients with Bladder Exstrophy has demonstrated mixed results compared to population samples. Few studies have had a comparison group with a urological disorder and none correlated body image to health related quality of life. We compared health related quality of life in patients with Bladder Exstrophy to that in patients with kidney stones and correlated body image to health related quality of life in the Bladder Exstrophy population.Materials and Methods: Participants included 24 patients with kidney stones and 24 with Bladder Exstrophy. Patient age was 8 to 25 years. Participants completed the PedsQL (Pediatric Quality of Life Inventory) and the 25-item multiple choice UBIQ (Urological Body Image Questionnaire), which was created for the current study.Results: Compared to patients with kidney stones those with Bladder Exstrophy indicated significantly higher scores on physical functioning (p = 0.0005) and overall health related quality of life (p...
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Health related quality of life in patients with Bladder Exstrophy: a call for targeted interventions.
The Journal of urology, 2014Co-Authors: Melanie Pennison, Lauren Mednick, Ilina Rosoklija, Rosemary Grant, Lin Huang, Sonja I. Ziniel, Diane Price, Joseph G. BorerAbstract:Research on health related quality of life in patients with Bladder Exstrophy has demonstrated mixed results compared to population samples. Few studies have had a comparison group with a urological disorder and none correlated body image to health related quality of life. We compared health related quality of life in patients with Bladder Exstrophy to that in patients with kidney stones and correlated body image to health related quality of life in the Bladder Exstrophy population. Participants included 24 patients with kidney stones and 24 with Bladder Exstrophy. Patient age was 8 to 25 years. Participants completed the PedsQL (Pediatric Quality of Life Inventory) and the 25-item multiple choice UBIQ (Urological Body Image Questionnaire), which was created for the current study. Compared to patients with kidney stones those with Bladder Exstrophy indicated significantly higher scores on physical functioning (p = 0.0005) and overall health related quality of life (p = 0.02) in the 8 to 17-year-old cohort. When health related quality of life was compared to body image in patients with Bladder Exstrophy, lower social scores were associated with those who worried about friends finding out about the condition (p = 0.01) and about having romantic relationships (p = 0.003). Lower social (p = 0.006) and emotional (p = 0.009) functioning scores were associated with patients who thought that they were less likely to have romantic relationships. The finding that patients with Bladder Exstrophy had a better physical functioning score than those with kidney stones is not surprising, given the morbidity of active stone disease. The negative correlations with body image in the Bladder Exstrophy population may be due to the possibility of others discovering the condition and the perceived likelihood of not having romantic relationships. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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Stress and Coping of Parents of Young Children Diagnosed With Bladder Exstrophy
The Journal of urology, 2009Co-Authors: Lauren Mednick, Patricio C. Gargollo, Rosemary Grant, Melisa Oliva, Joseph G. BorerAbstract:Purpose: Previous studies have examined the psychological impact that living with Bladder Exstrophy has on patients. However, little is known about how parents of children diagnosed with this condition are affected. We examine how parents caring for children diagnosed with Bladder Exstrophy are impacted. An increased understanding of the stressors these parents face may lead to the development of appropriate parenting interventions, which may ultimately affect psychosocial and health outcomes in the child.Materials and Methods: All parents of children 10 years and younger treated for Bladder Exstrophy at our institution were selected from a centralized database. A total of 20 parents (65% of the eligible population) completed standardized questionnaires assessing pediatric specific parenting stress (Pediatric Inventory for Parents) and coping (Ways of Coping Questionnaire).Results: Parents identified several common stressors (eg worrying about the long-term impact of the illness, helping the child with hi...
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prospective followup in patients after complete primary repair of Bladder Exstrophy
The Journal of Urology, 2008Co-Authors: Patricio C. Gargollo, Joseph G. Borer, Ilina Rosoklija, Rosemary Grant, David A Diamond, Hardy W Hendren, Alan B RetikAbstract:Purpose: The new technique of complete primary repair of Bladder Exstrophy has offered the promise of improved Bladder functional outcomes and yet longitudinal followup in patients with Exstrophy who have undergone this form of closure is sparse. We present our median 5-year data on patients who have undergone complete primary repair of Bladder Exstrophy.Materials and Methods: The records of patients who underwent complete primary repair of Bladder Exstrophy were analyzed retrospectively. Patients were followed prospectively using case report forms, radiological and clinical data, and semistructured parental and patient interviews. We reviewed parameters including clinical events, scarring on renal scan, vesicoureteral reflux, surgical procedures, urodynamic studies, urinary and fecal continence status, and episodes of urinary tract infection.Results: From 1994 to 2007 complete primary repair of Bladder Exstrophy was performed in 32 patients. Of these patients 28 underwent closure within 72 hours of life,...
Ilina Rosoklija - One of the best experts on this subject based on the ideXlab platform.
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combined cystometrography and electromyography of the external urethral sphincter following complete primary repair of Bladder Exstrophy
The Journal of Urology, 2014Co-Authors: Joseph G. Borer, Ilina Rosoklija, David A Diamond, Ruth Strakosha, Stuart B Bauer, Melanie Pennison, Shahram KhoshbinAbstract:Purpose: Concern in patients with Bladder Exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of Bladder Exstrophy. We determined whether complete primary repair of Bladder Exstrophy would adversely affect the innervation controlling Bladder and external urethral sphincter function.Materials and Methods: Complete primary repair of Bladder Exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding.Results: Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary re...
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Health Related Quality of Life in Patients with Bladder Exstrophy: A Call for Targeted Interventions
The Journal of Urology, 2014Co-Authors: Melanie Pennison, Lauren Mednick, Ilina Rosoklija, Rosemary Grant, D. A. Price, Lin Huang, Sonja I. Ziniel, Joseph G. BorerAbstract:Purpose: Research on health related quality of life in patients with Bladder Exstrophy has demonstrated mixed results compared to population samples. Few studies have had a comparison group with a urological disorder and none correlated body image to health related quality of life. We compared health related quality of life in patients with Bladder Exstrophy to that in patients with kidney stones and correlated body image to health related quality of life in the Bladder Exstrophy population.Materials and Methods: Participants included 24 patients with kidney stones and 24 with Bladder Exstrophy. Patient age was 8 to 25 years. Participants completed the PedsQL (Pediatric Quality of Life Inventory) and the 25-item multiple choice UBIQ (Urological Body Image Questionnaire), which was created for the current study.Results: Compared to patients with kidney stones those with Bladder Exstrophy indicated significantly higher scores on physical functioning (p = 0.0005) and overall health related quality of life (p...
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Health related quality of life in patients with Bladder Exstrophy: a call for targeted interventions.
The Journal of urology, 2014Co-Authors: Melanie Pennison, Lauren Mednick, Ilina Rosoklija, Rosemary Grant, Lin Huang, Sonja I. Ziniel, Diane Price, Joseph G. BorerAbstract:Research on health related quality of life in patients with Bladder Exstrophy has demonstrated mixed results compared to population samples. Few studies have had a comparison group with a urological disorder and none correlated body image to health related quality of life. We compared health related quality of life in patients with Bladder Exstrophy to that in patients with kidney stones and correlated body image to health related quality of life in the Bladder Exstrophy population. Participants included 24 patients with kidney stones and 24 with Bladder Exstrophy. Patient age was 8 to 25 years. Participants completed the PedsQL (Pediatric Quality of Life Inventory) and the 25-item multiple choice UBIQ (Urological Body Image Questionnaire), which was created for the current study. Compared to patients with kidney stones those with Bladder Exstrophy indicated significantly higher scores on physical functioning (p = 0.0005) and overall health related quality of life (p = 0.02) in the 8 to 17-year-old cohort. When health related quality of life was compared to body image in patients with Bladder Exstrophy, lower social scores were associated with those who worried about friends finding out about the condition (p = 0.01) and about having romantic relationships (p = 0.003). Lower social (p = 0.006) and emotional (p = 0.009) functioning scores were associated with patients who thought that they were less likely to have romantic relationships. The finding that patients with Bladder Exstrophy had a better physical functioning score than those with kidney stones is not surprising, given the morbidity of active stone disease. The negative correlations with body image in the Bladder Exstrophy population may be due to the possibility of others discovering the condition and the perceived likelihood of not having romantic relationships. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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prospective followup in patients after complete primary repair of Bladder Exstrophy
The Journal of Urology, 2008Co-Authors: Patricio C. Gargollo, Joseph G. Borer, Ilina Rosoklija, Rosemary Grant, David A Diamond, Hardy W Hendren, Alan B RetikAbstract:Purpose: The new technique of complete primary repair of Bladder Exstrophy has offered the promise of improved Bladder functional outcomes and yet longitudinal followup in patients with Exstrophy who have undergone this form of closure is sparse. We present our median 5-year data on patients who have undergone complete primary repair of Bladder Exstrophy.Materials and Methods: The records of patients who underwent complete primary repair of Bladder Exstrophy were analyzed retrospectively. Patients were followed prospectively using case report forms, radiological and clinical data, and semistructured parental and patient interviews. We reviewed parameters including clinical events, scarring on renal scan, vesicoureteral reflux, surgical procedures, urodynamic studies, urinary and fecal continence status, and episodes of urinary tract infection.Results: From 1994 to 2007 complete primary repair of Bladder Exstrophy was performed in 32 patients. Of these patients 28 underwent closure within 72 hours of life,...
Rosemary Grant - One of the best experts on this subject based on the ideXlab platform.
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Health Related Quality of Life in Patients with Bladder Exstrophy: A Call for Targeted Interventions
The Journal of Urology, 2014Co-Authors: Melanie Pennison, Lauren Mednick, Ilina Rosoklija, Rosemary Grant, D. A. Price, Lin Huang, Sonja I. Ziniel, Joseph G. BorerAbstract:Purpose: Research on health related quality of life in patients with Bladder Exstrophy has demonstrated mixed results compared to population samples. Few studies have had a comparison group with a urological disorder and none correlated body image to health related quality of life. We compared health related quality of life in patients with Bladder Exstrophy to that in patients with kidney stones and correlated body image to health related quality of life in the Bladder Exstrophy population.Materials and Methods: Participants included 24 patients with kidney stones and 24 with Bladder Exstrophy. Patient age was 8 to 25 years. Participants completed the PedsQL (Pediatric Quality of Life Inventory) and the 25-item multiple choice UBIQ (Urological Body Image Questionnaire), which was created for the current study.Results: Compared to patients with kidney stones those with Bladder Exstrophy indicated significantly higher scores on physical functioning (p = 0.0005) and overall health related quality of life (p...
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Health related quality of life in patients with Bladder Exstrophy: a call for targeted interventions.
The Journal of urology, 2014Co-Authors: Melanie Pennison, Lauren Mednick, Ilina Rosoklija, Rosemary Grant, Lin Huang, Sonja I. Ziniel, Diane Price, Joseph G. BorerAbstract:Research on health related quality of life in patients with Bladder Exstrophy has demonstrated mixed results compared to population samples. Few studies have had a comparison group with a urological disorder and none correlated body image to health related quality of life. We compared health related quality of life in patients with Bladder Exstrophy to that in patients with kidney stones and correlated body image to health related quality of life in the Bladder Exstrophy population. Participants included 24 patients with kidney stones and 24 with Bladder Exstrophy. Patient age was 8 to 25 years. Participants completed the PedsQL (Pediatric Quality of Life Inventory) and the 25-item multiple choice UBIQ (Urological Body Image Questionnaire), which was created for the current study. Compared to patients with kidney stones those with Bladder Exstrophy indicated significantly higher scores on physical functioning (p = 0.0005) and overall health related quality of life (p = 0.02) in the 8 to 17-year-old cohort. When health related quality of life was compared to body image in patients with Bladder Exstrophy, lower social scores were associated with those who worried about friends finding out about the condition (p = 0.01) and about having romantic relationships (p = 0.003). Lower social (p = 0.006) and emotional (p = 0.009) functioning scores were associated with patients who thought that they were less likely to have romantic relationships. The finding that patients with Bladder Exstrophy had a better physical functioning score than those with kidney stones is not surprising, given the morbidity of active stone disease. The negative correlations with body image in the Bladder Exstrophy population may be due to the possibility of others discovering the condition and the perceived likelihood of not having romantic relationships. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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Stress and Coping of Parents of Young Children Diagnosed With Bladder Exstrophy
The Journal of urology, 2009Co-Authors: Lauren Mednick, Patricio C. Gargollo, Rosemary Grant, Melisa Oliva, Joseph G. BorerAbstract:Purpose: Previous studies have examined the psychological impact that living with Bladder Exstrophy has on patients. However, little is known about how parents of children diagnosed with this condition are affected. We examine how parents caring for children diagnosed with Bladder Exstrophy are impacted. An increased understanding of the stressors these parents face may lead to the development of appropriate parenting interventions, which may ultimately affect psychosocial and health outcomes in the child.Materials and Methods: All parents of children 10 years and younger treated for Bladder Exstrophy at our institution were selected from a centralized database. A total of 20 parents (65% of the eligible population) completed standardized questionnaires assessing pediatric specific parenting stress (Pediatric Inventory for Parents) and coping (Ways of Coping Questionnaire).Results: Parents identified several common stressors (eg worrying about the long-term impact of the illness, helping the child with hi...
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prospective followup in patients after complete primary repair of Bladder Exstrophy
The Journal of Urology, 2008Co-Authors: Patricio C. Gargollo, Joseph G. Borer, Ilina Rosoklija, Rosemary Grant, David A Diamond, Hardy W Hendren, Alan B RetikAbstract:Purpose: The new technique of complete primary repair of Bladder Exstrophy has offered the promise of improved Bladder functional outcomes and yet longitudinal followup in patients with Exstrophy who have undergone this form of closure is sparse. We present our median 5-year data on patients who have undergone complete primary repair of Bladder Exstrophy.Materials and Methods: The records of patients who underwent complete primary repair of Bladder Exstrophy were analyzed retrospectively. Patients were followed prospectively using case report forms, radiological and clinical data, and semistructured parental and patient interviews. We reviewed parameters including clinical events, scarring on renal scan, vesicoureteral reflux, surgical procedures, urodynamic studies, urinary and fecal continence status, and episodes of urinary tract infection.Results: From 1994 to 2007 complete primary repair of Bladder Exstrophy was performed in 32 patients. Of these patients 28 underwent closure within 72 hours of life,...
Seppo Taskinen - One of the best experts on this subject based on the ideXlab platform.
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sexual function in patients operated on for Bladder Exstrophy and epispadias
The Journal of Urology, 2015Co-Authors: Seppo Taskinen, Janne S Suominen, Pekka SanttilaAbstract:Purpose: Bladder Exstrophy and epispadias complex is a rare congenital malformation that may have detrimental effects on sexual function. We evaluated sexual function of patients with Bladder Exstrophy and epispadias complex using validated questionnaires and compared the results with age matched controls.Materials and Methods: Patients with Bladder Exstrophy and epispadias complex treated between 1956 and 1992 were identified from our hospital operative database. A total of 63 patients were mailed questionnaires up to 3 times, resulting in 32 replies (51%). Men were mailed the International Index of Erectile Function-15 questionnaire and women were mailed the Female Sexual Function Index questionnaire, and all patients were asked auxiliary questions regarding children, satisfaction with external genitalia and urinary continence.Results: There were no differences in sexual function between sexually active men with Bladder Exstrophy and epispadias complex and age matched controls on different erectile func...