Summary
Introduction
In patients with classic bladder exstrophy (CBE), posterior urethral strictures after
primary bladder closure can be difficult to manage and therefore necessitate alternative
techniques in reconstruction of the proximal urethra. There is a paucity of literature
describing treatment and management of posterior urethral stricture arising after
repair of classic bladder exstrophy.
Objective
To describe the technique of a bladder neck reconstruction (BNR) with a modified Tanagho
anterior detrusor flap in the treatment of posterior urethral stricture arising after
repair of classic bladder exstrophy.
Patients and methods
A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients
was reviewed for patients who underwent bladder neck or proximal urethral reconstruction
with modified Tanagho flap for proximal urethral stricture disease from the time period
of 1975–2021. A total of 5 patients (1 female and 4 males) with classic bladder exstrophy
who underwent proximal urethral reconstruction with modified Tanagho flap were identified.
Of these 5 patients, the 1 female patient was treated for ongoing incontinence, not
posterior urethral stricture, and was thus excluded from this report. Outcomes measured
included post operative bladder capacity, post-operative continence status, upper
urinary tract status, and stricture recurrence.
Results
Four male patients with CBE were treated for posterior urethral strictures and are
reviewed here. Three patients underwent successful primary closure (1 via modern staged
repair of exstrophy (MSRE) and 2 via complete primary repair of exstrophy (CPRE)),
and 1 patient (MSRE) required repeat closure at the time of stricture repair. Mean
age at BNR Tanagho flap was 3.8 (range 2.3–5.0) years. All patients remained stricture
free with post-operative urinary incontinence; 2 patients underwent subsequent elective
bladder neck transection to achieve continence. Mean follow up 9.9 (range 2.1–15.6)
years.
Discussion
All 4 patients had excellent long term success rates, comparable to results reported
in several adult studies utilizing a modified Tanagho flap in women with post-traumatic
bladder neck contractures. In addition, our technique described here shares similarities
with both the originally described Tanagho flap as well as with a dorsal onlay graft
urethroplasty.
Conclusion
Graphical AbstractA-E: Cystotomy with creation of modified Tanagho Flap.
Keywords
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Article info
Publication history
Published online: October 18, 2022
Accepted:
October 8,
2022
Received in revised form:
September 3,
2022
Received:
May 10,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
