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John P Gearhart - One of the best experts on this subject based on the ideXlab platform.
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modified young dees leadbetter bladder Neck Reconstruction after exstrophy repair
The Journal of Urology, 2009Co-Authors: Todd Purves, Thomas E Novak, Jeremy A King, John P GearhartAbstract:Purpose: We describe the application and results of modified Young-Dees-Leadbetter bladder Neck Reconstruction after successful complete primary repair in the newborn period.Materials and Methods: The records of 34 patients referred for a continence procedure after successful exstrophy closure were extracted from an institutionally approved database. Patient characteristics and surgical outcomes were assessed.Results: A total of 31 male and 3 female patients were identified, of whom 27 and 1, respectively, underwent osteotomy at initial closure. No patients attained urinary continence and so they were referred for a continence procedure. Nine patients did not have adequate bladder capacity for bladder Neck repair (mean bladder capacity 63 ml, range 20 to 80). In those with suitable capacity mean capacity was 119 ml (range 85 to 180) and they underwent bladder Neck Reconstruction at a mean age of 4.9 years. Of the 25 patients who underwent bladder Neck repair 14 (56%) were dry during the day and night, 5 (...
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results of bladder Neck Reconstruction after newborn complete primary repair of exstrophy
The Journal of Urology, 2007Co-Authors: John P Gearhart, Andrew D Baird, Caleb P NelsonAbstract:Purpose: We describe the results of modified Young-Dees-Leadbetter bladder Neck Reconstruction to achieve continence in patients who underwent complete primary repair of bladder exstrophy as newborns.Materials and Methods: Using the Johns Hopkins Exstrophy Database we identified patients who underwent bladder Neck Reconstruction after having undergone complete primary repair of bladder exstrophy as newborns. We determined patient characteristics and surgical outcomes.Results: A total of 30 males and 3 females were referred after complete primary repair of bladder exstrophy, of whom 26 underwent bladder Neck Reconstruction. Results of complete primary repair of bladder exstrophy were strongly associated with osteotomy use. Of the patients 19 (58%), including 16 males and 3 females, who underwent complete primary repair of bladder exstrophy without osteotomy had complications (dehiscence and bladder prolapse), while none of 14 male patients who underwent complete primary repair of bladder exstrophy with ost...
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Results of bladder Neck Reconstruction after newborn complete primary repair of exstrophy.
The Journal of urology, 2007Co-Authors: John P Gearhart, Andrew Baird, Caleb P NelsonAbstract:We describe the results of modified Young-Dees-Leadbetter bladder Neck Reconstruction to achieve continence in patients who underwent complete primary repair of bladder exstrophy as newborns. Using the Johns Hopkins Exstrophy Database we identified patients who underwent bladder Neck Reconstruction after having undergone complete primary repair of bladder exstrophy as newborns. We determined patient characteristics and surgical outcomes. A total of 30 males and 3 females were referred after complete primary repair of bladder exstrophy, of whom 26 underwent bladder Neck Reconstruction. Results of complete primary repair of bladder exstrophy were strongly associated with osteotomy use. Of the patients 19 (58%), including 16 males and 3 females, who underwent complete primary repair of bladder exstrophy without osteotomy had complications (dehiscence and bladder prolapse), while none of 14 male patients who underwent complete primary repair of bladder exstrophy with osteotomy had complications, although none were subsequently continent. Of the 19 patients who had complications after complete primary repair of bladder exstrophy 12 underwent bladder Neck Reconstruction and total continence was achieved in only 3 (25%). Of the 14 patients with successful complete primary repair of bladder exstrophy 8 (57%) are dry day and night, 4 (28%) are dry during the day and wet at night, and 2 (14%) are completely incontinent. Continent children underwent successful complete primary repair of bladder exstrophy with pelvic osteotomy, all underwent hypospadias repair before age 1 year and none required ureteral reimplantation before bladder Neck Reconstruction. Many patients who undergo newborn complete primary repair of bladder exstrophy will require bladder Neck Reconstruction. Bladder Neck Reconstruction is more successful in those in whom complete primary repair of bladder exstrophy was successful. As in all types of repair, failed initial closure usually results in a bladder that is unsuitable for bladder Neck Reconstruction. These patients often require bladder augmentation and a continent stoma to be dry.
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combined bladder Neck Reconstruction and epispadias repair for exstrophy epispadias complex
The Journal of Urology, 2001Co-Authors: İlhami Sürer, Robert D. Jeffs, Linda A Baker, John P GearhartAbstract:Purpose: The achievement of satisfactory continence in the management of classic bladder exstrophy remains a surgical challenge. During the last 20 years a staged approach to the management of the exstrophy-epispadias complex has been used at many exstrophy centers to attain this goal. In select cases repairs can be combined to reduce the number of mandatory operations to achieve continence. We retrospectively review our experience with, and long-term results and complications of combined bladder Neck Reconstruction and epispadias repair.Materials and Methods: A total of 19 boys with classic bladder exstrophy (17) and complete male epispadias (2) underwent combined bladder Neck Reconstruction and epispadias repair between 1982 and 1999. Primary closure was performed elsewhere in 16 cases and osteotomy was performed at primary closure in 8 (42%). All patients have undergone modified Cantwell-Ransley epispadias repair except for 2 who underwent a Young procedure.Results: At the time of combined bladder Neck...
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Failed Bladder Neck Reconstruction: Options for Management
The Journal of urology, 1991Co-Authors: John P Gearhart, Douglas A. Canning, Robert D. JeffsAbstract:AbstractDuring the last 10 years 17 patients have been seen at this institution for persistent urinary incontinence after Young-Dees-Leadbetter bladder Neck Reconstruction. Of these patients 16 were born with classical bladder exstrophy and 1 with complete epispadias. Six patients underwent 1, 10 underwent 2 and 1 underwent 3 prior bladder Neck procedures. As salvage procedures 8 patients underwent another Young-Dees-Leadbetter procedure, 1 repeat bladder Neck Reconstruction and augmentation cystoplasty, 3 augmentation alone, 4 bladder augmentation with creation of a continent abdominal stoma and 1 augmentation with implantation of an artificial urinary sphincter. Of the 8 patients who underwent a repeat Young-Dees-Leadbetter procedure 7 are dry for 3 hours or more and 1 is dry for greater than 3 hours on intermittent self-catheterization. All of those who are dry for greater than 3 hours are dry at night and 1 wears pads when engaging in strenuous physical activity. Of the 9 patients who underwent augmen...
Joseph G Borer - One of the best experts on this subject based on the ideXlab platform.
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bladder Neck Reconstruction is often necessary after complete primary repair of exstrophy
The Journal of Urology, 2011Co-Authors: Patricio C Gargollo, Ilina Rosoklija, Hardy W Hendren, David A Diamond, Melanie Pennison, Rosemary Grant, Alan B Retik, Joseph G BorerAbstract:Purpose: A major goal of bladder exstrophy management is urinary continence, often using bladder Neck Reconstruction. We report our experience with bladder Neck Reconstruction after complete primary repair of exstrophy.Materials and Methods: Patient history, ultrasound, voiding cystourethrogram, examination using anesthesia and urodynamics were performed during a prospective evaluation. Continence was assessed using the International Children's Continence Society classification and the dry interval. Bladder capacity was measured by examination using anesthesia, voiding cystourethrogram and/or urodynamics. Urodynamics were also done to assess bladder compliance and detrusor muscle function.Results: From 1994 to 2010 we treated 31 male and 15 female patients with bladder exstrophy after complete primary repair of exstrophy. Of patients 5 years old or older bladder Neck Reconstruction was performed after complete primary repair in 9 of 21 males (43%) and in 3 of 11 females (27%) at a mean age of 6.3 and 8.1 ...
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Bladder Neck Reconstruction is often necessary after complete primary repair of exstrophy.
The Journal of urology, 2011Co-Authors: Patricio C Gargollo, Ilina Rosoklija, David A Diamond, Melanie Pennison, Rosemary Grant, Alan B Retik, W Hardy Hendren, Joseph G BorerAbstract:A major goal of bladder exstrophy management is urinary continence, often using bladder Neck Reconstruction. We report our experience with bladder Neck Reconstruction after complete primary repair of exstrophy. Patient history, ultrasound, voiding cystourethrogram, examination using anesthesia and urodynamics were performed during a prospective evaluation. Continence was assessed using the International Children's Continence Society classification and the dry interval. Bladder capacity was measured by examination using anesthesia, voiding cystourethrogram and/or urodynamics. Urodynamics were also done to assess bladder compliance and detrusor muscle function. From 1994 to 2010 we treated 31 male and 15 female patients with bladder exstrophy after complete primary repair of exstrophy. Of patients 5 years old or older bladder Neck Reconstruction was performed after complete primary repair in 9 of 21 males (43%) and in 3 of 11 females (27%) at a mean age of 6.3 and 8.1 years, respectively. By the International Children's Continence Society classification 6 of 12 patients (50%) were continent less than 1.5 years after bladder Neck Reconstruction and 2 of 9 (23%) were evaluable 1.5 years or greater after Reconstruction. Median bladder capacity was 100 ml before, 50 ml less than 1.5 years after and 123 ml 1.5 years or greater after bladder Neck Reconstruction. Three males and 2 females emptied via an appendicovesicostomy. Two boys underwent augmentation. In our experience most patients with bladder exstrophy require bladder Neck Reconstruction after complete primary repair of exstrophy. The need for Reconstruction is more common in males. Our rates of bladder Neck Reconstruction after complete primary repair of exstrophy and of continence after bladder Neck Reconstruction are similar to those in other reports. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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The use of bladder Neck Reconstruction in bladder exstrophy
Seminars in pediatric surgery, 2011Co-Authors: Joseph G BorerAbstract:A major goal of bladder exstrophy (BE) management is achieving urinary continence, most commonly with surgical bladder Neck Reconstruction (BNR). This is a report of outcome of BNR after complete primary repair of exstrophy (CPRE). At our institution, patient history, ultrasound, cystogram (VCUG) and urodynamic study (UDS) were performed during a prospective evaluation of patients with BE. Dry interval of >3 hours was used as the definition of continence and dry interval P = 0.013) and from P = 0.002). In conclusion, most patients with BE require BNR after CPRE. The need for BNR is more common in male patients.
Caleb P Nelson - One of the best experts on this subject based on the ideXlab platform.
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results of bladder Neck Reconstruction after newborn complete primary repair of exstrophy
The Journal of Urology, 2007Co-Authors: John P Gearhart, Andrew D Baird, Caleb P NelsonAbstract:Purpose: We describe the results of modified Young-Dees-Leadbetter bladder Neck Reconstruction to achieve continence in patients who underwent complete primary repair of bladder exstrophy as newborns.Materials and Methods: Using the Johns Hopkins Exstrophy Database we identified patients who underwent bladder Neck Reconstruction after having undergone complete primary repair of bladder exstrophy as newborns. We determined patient characteristics and surgical outcomes.Results: A total of 30 males and 3 females were referred after complete primary repair of bladder exstrophy, of whom 26 underwent bladder Neck Reconstruction. Results of complete primary repair of bladder exstrophy were strongly associated with osteotomy use. Of the patients 19 (58%), including 16 males and 3 females, who underwent complete primary repair of bladder exstrophy without osteotomy had complications (dehiscence and bladder prolapse), while none of 14 male patients who underwent complete primary repair of bladder exstrophy with ost...
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Results of bladder Neck Reconstruction after newborn complete primary repair of exstrophy.
The Journal of urology, 2007Co-Authors: John P Gearhart, Andrew Baird, Caleb P NelsonAbstract:We describe the results of modified Young-Dees-Leadbetter bladder Neck Reconstruction to achieve continence in patients who underwent complete primary repair of bladder exstrophy as newborns. Using the Johns Hopkins Exstrophy Database we identified patients who underwent bladder Neck Reconstruction after having undergone complete primary repair of bladder exstrophy as newborns. We determined patient characteristics and surgical outcomes. A total of 30 males and 3 females were referred after complete primary repair of bladder exstrophy, of whom 26 underwent bladder Neck Reconstruction. Results of complete primary repair of bladder exstrophy were strongly associated with osteotomy use. Of the patients 19 (58%), including 16 males and 3 females, who underwent complete primary repair of bladder exstrophy without osteotomy had complications (dehiscence and bladder prolapse), while none of 14 male patients who underwent complete primary repair of bladder exstrophy with osteotomy had complications, although none were subsequently continent. Of the 19 patients who had complications after complete primary repair of bladder exstrophy 12 underwent bladder Neck Reconstruction and total continence was achieved in only 3 (25%). Of the 14 patients with successful complete primary repair of bladder exstrophy 8 (57%) are dry day and night, 4 (28%) are dry during the day and wet at night, and 2 (14%) are completely incontinent. Continent children underwent successful complete primary repair of bladder exstrophy with pelvic osteotomy, all underwent hypospadias repair before age 1 year and none required ureteral reimplantation before bladder Neck Reconstruction. Many patients who undergo newborn complete primary repair of bladder exstrophy will require bladder Neck Reconstruction. Bladder Neck Reconstruction is more successful in those in whom complete primary repair of bladder exstrophy was successful. As in all types of repair, failed initial closure usually results in a bladder that is unsuitable for bladder Neck Reconstruction. These patients often require bladder augmentation and a continent stoma to be dry.
Patricio C Gargollo - One of the best experts on this subject based on the ideXlab platform.
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bladder Neck Reconstruction is often necessary after complete primary repair of exstrophy
The Journal of Urology, 2011Co-Authors: Patricio C Gargollo, Ilina Rosoklija, Hardy W Hendren, David A Diamond, Melanie Pennison, Rosemary Grant, Alan B Retik, Joseph G BorerAbstract:Purpose: A major goal of bladder exstrophy management is urinary continence, often using bladder Neck Reconstruction. We report our experience with bladder Neck Reconstruction after complete primary repair of exstrophy.Materials and Methods: Patient history, ultrasound, voiding cystourethrogram, examination using anesthesia and urodynamics were performed during a prospective evaluation. Continence was assessed using the International Children's Continence Society classification and the dry interval. Bladder capacity was measured by examination using anesthesia, voiding cystourethrogram and/or urodynamics. Urodynamics were also done to assess bladder compliance and detrusor muscle function.Results: From 1994 to 2010 we treated 31 male and 15 female patients with bladder exstrophy after complete primary repair of exstrophy. Of patients 5 years old or older bladder Neck Reconstruction was performed after complete primary repair in 9 of 21 males (43%) and in 3 of 11 females (27%) at a mean age of 6.3 and 8.1 ...
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Bladder Neck Reconstruction is often necessary after complete primary repair of exstrophy.
The Journal of urology, 2011Co-Authors: Patricio C Gargollo, Ilina Rosoklija, David A Diamond, Melanie Pennison, Rosemary Grant, Alan B Retik, W Hardy Hendren, Joseph G BorerAbstract:A major goal of bladder exstrophy management is urinary continence, often using bladder Neck Reconstruction. We report our experience with bladder Neck Reconstruction after complete primary repair of exstrophy. Patient history, ultrasound, voiding cystourethrogram, examination using anesthesia and urodynamics were performed during a prospective evaluation. Continence was assessed using the International Children's Continence Society classification and the dry interval. Bladder capacity was measured by examination using anesthesia, voiding cystourethrogram and/or urodynamics. Urodynamics were also done to assess bladder compliance and detrusor muscle function. From 1994 to 2010 we treated 31 male and 15 female patients with bladder exstrophy after complete primary repair of exstrophy. Of patients 5 years old or older bladder Neck Reconstruction was performed after complete primary repair in 9 of 21 males (43%) and in 3 of 11 females (27%) at a mean age of 6.3 and 8.1 years, respectively. By the International Children's Continence Society classification 6 of 12 patients (50%) were continent less than 1.5 years after bladder Neck Reconstruction and 2 of 9 (23%) were evaluable 1.5 years or greater after Reconstruction. Median bladder capacity was 100 ml before, 50 ml less than 1.5 years after and 123 ml 1.5 years or greater after bladder Neck Reconstruction. Three males and 2 females emptied via an appendicovesicostomy. Two boys underwent augmentation. In our experience most patients with bladder exstrophy require bladder Neck Reconstruction after complete primary repair of exstrophy. The need for Reconstruction is more common in males. Our rates of bladder Neck Reconstruction after complete primary repair of exstrophy and of continence after bladder Neck Reconstruction are similar to those in other reports. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Chung Hwan Baek - One of the best experts on this subject based on the ideXlab platform.
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Scapular Tip Free Flap for Head and Neck Reconstruction
Clinical and experimental otorhinolaryngology, 2015Co-Authors: Nayeon Choi, Jae Keun Cho, Jeon Yeob Jang, Jung Kyu Cho, Young Sang Cho, Chung Hwan BaekAbstract:Objectives Head and Neck Reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF).
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Scapular Tip Free Flap for Head and Neck Reconstruction
Korean Society of Otorhinolaryngology-Head and Neck Surgery, 2015Co-Authors: Nayeon Choi, Jae Keun Cho, Jeon Yeob Jang, Jung Kyu Cho, Young Sang Cho, Chung Hwan BaekAbstract:ObjectivesHead and Neck Reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF).MethodsThis was a retrospective study of 17 patients undergoing maxillectomy and mandibulectomy and either primary or secondary Reconstruction by STFF. This study included surgical, esthetic, and functional outcomes, and detailed data are presented regarding the flap, such as pedicle length, size of the harvested bone, and failure rate. Medical photographs were used to estimate the esthetic outcome, and computed tomography was used to check the flap status postoperatively.ResultsThe data were collected from April 2013 to April 2014. Eight patients underwent maxillary Reconstruction, and nine underwent mandibular Reconstruction. Maxillary defects usually included unilateral alveolar structures and the palate; mandibular defects were usually those involving mandibular angle and short segment. Vein grafting was not required in any of the patients. Flap failure occurred in one of the 17 patients (5.9%) with successful Reconstruction after revision. Of the eight maxillectomy patients, orbital revisions for diplopia after maxillary Reconstruction were performed in two patients (25%), and oroantral fistula repair was performed in one patient (12.5%).ConclusionThis study demonstrated the reconstructive advantages of the angular branch-based STFF, long pedicle, low flap failure, 3-dimensional nature of bone and soft tissues (chimeric flap), and small rate of donor site morbidity with free ambulation. This flap is an excellent option for use in complex three-dimensional head and Neck Reconstruction
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Head and Neck Reconstruction using lateral thigh free flap: flap design.
Microsurgery, 1999Co-Authors: Chung Hwan BaekAbstract:Eleven lateral thigh free flaps were used in head and Neck Reconstruction, transferred on the basis of the second perforator as well as the third perforator of the profunda femoris artery. The lateral thigh free flap was useful and reliable in head and Neck Reconstruction and was versatile in flap design. Due to the wide cutaneous territory of the lateral thigh flap, the skin island could be designed freely in the lateral thigh region. Careful patient selection is mandatory for good results. The pinch test and an understanding of the variety of subcutaneous thicknesses in the lateral thigh region are helpful in designing a skin island of adequate thickness. Other considerations in flap design are discussed.
