REHABILITATION OF THE PATIENTS WITH BLADDER EXSTROPHY

Akhunzyanov AA, Rashitov LF

Kazan State Medical University,

Children's Republican Clinical Hospital, Kazan, Russia

 

Bladder exstrophy ¡ª several defect of development of the lower part of urinary system. Influence of this defect on psychosexually and the socio economic development of the patients results in sharp decrease of their quality of life. The most difficult medico-social problem in rehabilitation of the patients with bladder exstrophy for today is the liquidation of urine incontinence. The experience of clinic of children's surgery of Kazan on treatment of the patients with bladder exstrophy actuates 39 children (27 boys and 12 girls). Problems of operating interferences directed to liquidation of urinary incontinence, recovery of the miction act by a natural way, formation of external genitalia and reaching good cosmetological outcomes. With this purpose the patient with bladder exstrophy applied reconstructive- plastic operations on a technique G.A. Bairov and R. Gross with including of own development (19). Quite often in a course of primary operation it was possible to execute only cystoplastica, and the solution of other problems should be puted aside on more remote terms in connection with a general severy condition of the child, availability several associated defects of development etc. After primary operation children passed multi-stage rates of treatment in conditions od urological and nephrological departments, and also on a residence under supervision pediatrics, children's surgeons and urologists. During repeated hospitalisation the patient conducted treatment secondary pyelonephritis, the complications after primary cystoplastica were eliminated. By the reasons of urinary incontinence in postoperative period were small volume of a bladder, insufficiency it sphicter and disturbance of innervations of inherent character. In such cases applied ballonic dilatation of a bladder (9), plastic bladder neck on a technique V.M. Derjavin (8), injection in parauretral tissue homo- and heterosubstrats (4). The remote outcomes were inspected on terms till 30 years: the good outcomes are obtained in 25,6 % of cases, satisfactory ¡ª 51,2 % and unsatisfactory ¡ª 23,6 % cases. Thus, the rehabilitation of the patients with bladder exstrophy is multi-stage process and is directed on anatomic recovery of urinary tract and improving of quality of life of the patients.

 
2103