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POST-OPERATIVE DIAGNOSIS:

Status post 2 failed closures of bladder exstrophy in the Soviet Union with third successful closure at Johns Hopkins.

PROSTHETIC DEVICE/IMPLANT:

NARRATIVE:

First Assistant: Ezekiel Young, MD

Second Assistant: Debasish Sundi, M.D.

Description of Operation:

With the patient in supine position and suitable general endotracheal anesthesia had been obtained, abdomen and genitalia were prepped and draped in the usual manner. A 10-French catheter was placed in the bladder. Gravity cystogram was obtained, which revealed the same bladder capacity as it was in last fall. A midline incision was then made with a #15 blade and deepened with electrocautery. There was no umbilicus present. We then went down to the fascia with electrocautery, opened the fascia with a knife and Metzenbaum scissors, split the muscle in the midline, entered the peritoneal cavity between sequential hemostats and opened the peritoneum all the way down into the pelvis and placed a large Denis Browne retractor. The bladder which had been filled in a retrograde fashion with a 10- French catheter left in, was then opened between 2 sutures of 3-0 Vicryl down to the bladder neck and the Denis Browne retractor was placed. The vagina had been douched free on the operating table during the prep with Betadine x3. It was then irrigated with saline x3. Once we went down to the bladder neck, we could see the vagina just distal to the bladder neck area. This was also seen at the time of her third exstrophy closure.

We then came acrossthe bladder neck and the opening of the vagina to the former urogenitalsinus electrocautery. The bladder was dissected up off the vaginal wall withsharp and blunt dissection.