Abstract
In cases of failed exstrophic closure, total cystectomy is sometimes performed combined with external urinary diversion or ureterosigmoidostomy. Prolonged life expectation and the request for a high quality of life, characteristic of pediatric and juvenile age, make it mandatory to look for different surgical solutions.
Among 44 patients (26 males and 18 females) born with “exstrophy-epispadias complex”, the creation of a new orthotopic urinary reservoir, according to the “Indiana Pouch” technique, was chosen in 2 children, 4 and 9 years of age respectively, who had previously undergone a total cystectomy elsewhere. The reservoir is made of a ceco-colic segment 35 cm long detubularized on one tenia and remodelled. Ureters are reimplanted with an antireflux technique on the second tenia. Continence is assured by the ileo-cecal valve opportunely reinforced.
Both patients are now perfectly continent day and night and voiding is assured by transurethral intermittent catheterization.
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