WOFAPS 2025 8th World Congress of Pediatric Surgery

Hammou Benslimane, Fatema Hadjou Belaid

faculté de médecine d'Oran Algérie

Purpose:Surgical dehiscence remains a major complication in the management of bladder exstrophy. The standard approach—reclosure with pubic osteotomy—often results in limited continence, even after multiple procedures. This study reports our experience with the use of musculo-aponeurotic flaps to prevent dehiscence and improve the success of primary bladder exstrophy repair, without requiring pelvic osteotomy.Materials and Methods:With approval from the institutional ethics committee, we conducted a retrospective study of patients treated for bladder exstrophy between 2019 and 2023. All children underwent single-stage closure of the bladder and abdominal wall using musculo-aponeurotic flaps, without pelvic osteotomy. Results:A total of 9 children underwent single-stage bladder exstrophy repair with musculo-aponeurotic flap coverage. The surgical protocol included: Epispadias repair in all patients, at a mean age of 12 months; Ureteral reimplantation performed during the initial procedure; Bladder neck reconstruction via Young-Dees cervicoplasty with neck lengthening.All patients had uneventful postoperative courses. No surgical revisions were required. Follow-up imaging showed no upper urinary tract dilation. Voiding cystourethrograms (VCUGs) were not routinely performed, as no patients presented with urinary tract infections or signs of impaired renal function.Conclusion:Successful closure of the bladder plate is critical in the management of bladder exstrophy, though continence remains a long-term challenge. Our findings suggest that musculo-aponeurotic flap reconstruction offers a reliable, technically straightforward method for preventing dehiscence. This approach allows for single-stage repair without osteotomy; early postoperative feeding;simultaneous epispadias repair, regardless of age;avoidance of prolonged immobilization.We propose this technique as a viable alternative to traditional, multi-staged or osteotomy-reliant strategies in bladder exstrophy management.