Minimally invasive approach as an ancillary intervention post adult primary bladder exstrophy closure: Minimizing the morbidity

Abstract

Introduction and objectives: The exstrophy-epispadias complex, including classical and cloacal exstrophy, significantly impacts physical, functional, and psychological health. Adults with primary bladder exstrophy repair often face persistent urinary incontinence due to a patulous bladder neck and reduced bladder capacity. Previous surgeries increase the risks of open procedures. Various studies have used open augmentation cystoplasty and robotic approaches in pediatric patients, not as minimally invasive techniques in adult patients with post exstrophy repair issues. We describe Robotic surgical augmentation cystoplasty which offers a minimally invasive alternative with promising outcomes, reducing postoperative complications, and facilitating adjunct procedures for post-bladder exstrophy repair issues. Patients and surgical procedure: This study presents three urological reconstruction cases. The first involves a patient with primary bladder exstrophy and epispadias repair facing urinary incontinence and limited bladder capacity. The second involves a post-bladder exstrophy repair patient with bladder neck reconstruction in childhood. Both above patient underwent Robotic augmentation cystoplasty. The third case discusses a patient with continuous urinary incontinence post-primary exstrophy repair, treated with robotic Kropp's repair and augmentation cystoplasty. Results: All patients maintained normal renal function without complications. Two patients had no postoperative issues and a urine holding capacity of two hours. The Kropp's procedure patient had less capacity and more frequent micturition. All patients were cosmetically satisfied. Conclusion: Robotic augmentation cystoplasty is a minimally invasive solution for small bladder capacity post-bladder exstrophy repair in adults. It improves urine holding capacity and minimizes postoperative complications, enhancing urological reconstruction and quality of life for these patients.

Keywords

• Robotic augmentation cystoplasty
• Bladder exstrophy repair
• Urinary incontinence
• Small capacity bladder
• Kropp's procedure