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.