Types of Surgery
There may be two options for surgical correction. Urinary Diversion In this following procedures are performed:
1) Uretero sigrnoidostomy if there is no anal incontinence
2) Illeal conduit
3) Colonic conduit with entire flux procedure.
Primary Reconstruction of Bladder
In this following steps are followed.
a) At birth-bladder closure or "Turning in" without the repair of bladder neck is done and abdominal wall is closed over the rotational flaps.
b) At 2-3 years of age: Chordae correction. Elongation of penis and Ducket's para extrophy flaps are raised. In this bladder neck is receded into pelvis. Following this repair of bladder neck and entire flux procedure is also done.
c) If continence is achieved and upper urinary tracts are normal, repair of epispadias is done.
d) If continence is good but child is dry only for short intervals, then at the age of 7-8 years augmentation of bladder capacity is done by colocystoplasty.
Postoperative care includes monitoring of vital signs, combating shock and watch and prevent bleeding from operation site. Position the child in such a way so as to prevent kinking of any drainage tubing.
- Keep abdominal dressing clean and dry.
- Maintain adequate fluid intake.
- Watch for fever, hematuria or purulent drainage from the incision.
All these activities should be performed with involvement of parents so that they can do this at home after discharge.