Paraexstrophy skin flaps for the primary closure of exstrophy in boys: outmoded or updated?

Journal Article (Journal Article)

PURPOSE: We evaluated the current application of Duckett paraexstrophy skin flaps for bladder exstrophy reconstruction. MATERIALS AND METHODS: We reviewed the records of cases of classic exstrophy treated at our institution between September 1993 and March 2007. A total of 21 patients were identified in whom modified Duckett paraexstrophy skin flaps were used in bladder closure at our institution. Another 12 patients were referred during the same time after closure with complications with flap use. RESULTS: Of the 21 patients who underwent closure at our institution with our modified version of the Duckett flaps 1 (4%) had a complication, that is urethral stricture. This responded to internal urethrotomy and daily intermittent catheterization for 4 months, and the stricture stabilized. Four of the 12 referred patients responded to multiple urethral dilations, 3 underwent open repair with a buccal graft, 2 received a full-thickness skin graft and 3 underwent internal urethrotomy with daily intermittent catheterization for 4 months. Of our 21 patients with internal treatment 14 underwent bladder neck repair, 5 underwent epispadias repair and 2 were awaiting further reconstruction. Six of the 12 referred patients underwent bladder neck repair, 4 underwent epispadias repair and 2 were awaiting further reconstruction. CONCLUSIONS: By modifying our version of the Duckett paraexstrophy skin flaps we have lowered our complication rate significantly. While overall use of these flaps has continued to decrease, when they are required, these modifications help avoid complicating strictures and their sequelae in the bladder and upper urinary tract.

Full Text

Duke Authors

Cited Authors

  • Purves, JT; Gearhart, JP

Published Date

  • October 2008

Published In

Volume / Issue

  • 180 / 4 Suppl

Start / End Page

  • 1675 - 1678

PubMed ID

  • 18708214

Electronic International Standard Serial Number (EISSN)

  • 1527-3792

Digital Object Identifier (DOI)

  • 10.1016/j.juro.2008.03.088


  • eng

Conference Location

  • United States