Turn-in and epispadias repair as the first step of 2-stage bladder exstrophy repair - A preliminary report.

BACKGROUND

We report Bladder Turn-in & Epispadias Repair (TIER) as a first step of two-staged Bladder Exstrophy repair.

TECHNIQUE: Circumferential incision was made around the bladder and urethral plate. Penis was degloved and corporal bodies were mobilised. The epispadiac urethra and spongiosa were dissected off the corporal bodies leaving the frenulum and prepuce attached to hemi-glans. Perineal muscle was identified by muscle stimulator and wrapped around the bladder neck. Bladder was closed leaving reimplantation/bladder neck repair to second stage. The neourethra was tubularised and meatus fashioned within the glans. No osteotomy/radical mobilisation was done; rectus muscles were mobilised from periosteal attachment for midline closure. Ventral skin flaps were used for penile skin cover.

RESULTS

Between 2020 and 2024, eleven male infants (median age 3-months) were operated. None had glans loss, bladder neck fistula or renal damage. 1/11 (9%) had superficial dehiscence. The mean bladder capacity was 150 ml; 5/11 (45.45%) completed second stage: reimplantation & bladder neck repair; 4/5 had dry period >2 h. None had recurrent urine infections or upper tract deterioration (median follow-up: 3 years).

CONCLUSION

This pilot study reports two-stage TIER where bladder closure/with perineal muscle approximation and epispadias repair are performed at first stage enabling bladder growth from modest outlet resistance allowing staged ureteric reimplantation in a safe setting. IRB approval: IEC-NI/24/Feb/92/41.