The Role of Human Acellular Dermis in Preventing Fistulas After Bladder Neck Transection in the Exstrophy-epispadias Complex
| Autor: | Heather N. Di Carlo, John P. Gearhart, Matthew Kasprenski, Gregory Joice, John Jayman, Mahir Maruf, Karl Benz, Nikolai A. Sopko |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Acellular Dermis medicine.medical_specialty Epispadias Adolescent Urology Urinary Bladder 030232 urology & nephrology Fibrin Tissue Adhesive Perineum Vesicovaginal fistula Surgical Flaps Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Urethral Diseases medicine Humans Child Retrospective Studies Vesicovaginal Fistula Urinary Bladder Fistula business.industry Bladder Exstrophy Soft tissue Middle Aged medicine.disease Cloacal exstrophy Surgery Bladder exstrophy Neck of urinary bladder medicine.anatomical_structure Child Preschool 030220 oncology & carcinogenesis Female Tissue Adhesives business Follow-Up Studies |
| Zdroj: | Urology. 117:137-141 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2018.04.011 |
| Popis: | Objective To evaluate human acellular dermis (HAD) as an adjunct during bladder neck transection (BNT) by comparing surgical outcomes with other types of tissue interposition. Methods A prospectively maintained institutional database of exstrophy-epispadias complex (EEC) patients was reviewed for those who underwent a BNT with at least 6 months follow-up. The primary outcome was the occurrence of BNT-related fistulas. Results In total, 147 EEC patients underwent a BNT with a mean follow-up time of 6.9 years (range 0.52-23.35 years). There were 124 (84.4%) classic exstrophy patients, 22 (15.0%) cloacal exstrophy patients, and 1 (0.7%) penopubic epispadias patient. A total of 12 (8.2%) BNTs resulted in fistulization, including 4 vesicoperineal fistulas, 7 vesicourethral fistulas, and 1 vesicovaginal fistula. There were 5 (22.7%) fistulas in the cloacal exstrophy cohort and 7 (5.6%) fistulas in the classic bladder exstrophy cohort (P = .019). Using either HAD or native tissue flaps resulted in a lower fistulization rate than using no interposed layers (5.8% vs 20.8%; P = .039). Of those with HAD, the use of a fibrin sealant did not decrease fistulization rates when compared to HAD alone (6.5% vs 8.8%, P = .695). There was no statistical difference in surgical complications between the use of HAD and native flaps (8.6% vs 5%, P = .716). Conclusion Use of soft tissue flaps and HAD is associated with decreased fistulization rates after BNT. HAD is a simple option and an effective adjunct that does not require harvesting of tissues in patients where a native flap is not feasible. |
| Databáze: | OpenAIRE |
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