Reconstructive Urologic Surgery in Children
The reconstructive surgery program in the Division of Urology at The Children's Hospital of Philadelphia pioneered many of the surgical procedures that are used throughout the world today. These include repairs for bladder exstrophy, cloacal exstrophy, spina bifida, hypospadias and epispadias.
Hypospadias repair
Bladder exstrophy
Repairs for children with spina bifida
Hypospadias repair
Hypospadias is a condition that affects the development of the urethra along with the tissues that make up the undersurface of the penis. Procedures to correct the condition include MAGPI repair and transverse island onlay and tube repairs. These techniques have been refined over the years and have significantly improved the surgical outcome of children with this condition.
Bladder exstrophy
Bladder exstrophy is a rare congenital anomaly in which the bladder and urethra have not formed properly, leading to herniation through the anterior abdominal anterior wall. In addition, the pubic bone remains widened so that orthopedic correction is also necessary. A team, which includes a urologic and an orthopedic surgeon, work together to close the bladder and reconstruct the bladder neck and urethra so that the bladder can fill and empty normally. Further reconstructive work to repair the remaining urethral and penile defect may be safely accomplished in a subsequent surgery.
Repairs for children with spina bifida
Children who are born with spina bifida may have profound problems with bladder and bowel function. Early management of these patients is critical in order to reduce the chances that they will need one or more surgeries. Surgery, however, may be appropriate for those patients whose incontinence cannot be controlled through medical measures. (For more information on managing incontinence without surgery, see our DOVE program page).
The Urology division was the first in North America to embrace the notion of a catheterizable channel constructed out of appendix. Known as an appendicovesicostomy, the procedure was initially performed 25 years ago. This technique facilitates children's catheterization and has provided autonomy for many adolescent patients to allow them to perform their own catheterizations. This procedure is generally combined with additional surgical procedures to increase the capacity of the bladder and, many times, with procedures that decrease the chances of urinary leakage via the urethra.
Some patients benefit from the creation of a catheterizable channel leading to the colon. Such a procedure facilitates the antegrade evacuation of the colon so that children will not leak stool in between their enemas. These procedures have also been performed using minimally invasive techniques.
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