Our Summary

This research paper discusses a surgical procedure to improve the physical appearance of girls with a condition called classic bladder exstrophy. This condition affects the urinary bladder and urethra, and also causes physical abnormalities in the genital area. Traditionally, during surgery, the lower abdomen is closed and the clitoris, which is split in two in these patients, is brought closer together. However, this often leaves a gap that grows larger over time. The authors of the paper propose a different surgical technique, called a vertical z plasty closure, which provides a two-layer closure and decreases tension. This method also recreates a clitoral hood, giving a more normal appearance to the genitals. The goal of this research is to improve the cosmetic outcome for girls with bladder exstrophy.

FAQs

  1. What is bladder exstrophy in females and how does it affect the genitalia?
  2. What is the purpose of a vertical z plasty closure in the treatment of bladder exstrophy?
  3. How does a vertical z plasty closure improve the cosmetic appearance of the external genitalia in girls with bladder exstrophy?

Doctor’s Tip

A doctor might recommend to a patient undergoing a z-plasty procedure to follow post-operative care instructions carefully, including keeping the incision site clean and dry, avoiding excessive movement or stretching of the area, and attending follow-up appointments to monitor healing progress. It is also important to communicate any concerns or complications to the doctor promptly.

Suitable For

Patients with bladder exstrophy, particularly females with a bifid clitoris and short labia minora, may be recommended for a vertical z-plasty closure to improve the cosmetic appearance of the external genitalia. This procedure can help decrease tension and recreate a more normal appearance of the clitoral hood, providing a better aesthetic outcome for these patients.

Timeline

Before z-plasty:

  • Patient is diagnosed with bladder exstrophy, resulting in an exstrophic bladder and urethra, an anterior introitus with a bifid clitoris and short labia minora.
  • Lower abdominal wall is closed during closure surgery, but the clitoral bodies are often not completely closed to prevent injury, leaving a persistent gap between them.

After z-plasty:

  • Vertical z-plasty closure is performed to provide a 2 layer closure of the mons, decreasing tension and improving cosmetic appearance.
  • Clitoral hood is recreated, providing a more normal appearance of the external genitalia for girls with bladder exstrophy.

What to Ask Your Doctor

  1. How will a z-plasty closure procedure benefit me in terms of improving the cosmetic appearance of my external genitalia?
  2. What are the potential risks and complications associated with a z-plasty closure for bladder exstrophy?
  3. How long is the recovery time after a z-plasty closure procedure?
  4. Will I need any additional procedures or follow-up appointments after the z-plasty closure?
  5. Are there any specific post-operative care instructions I should follow to ensure optimal healing and results?
  6. Can you provide me with before and after photos of patients who have undergone a z-plasty closure for bladder exstrophy?
  7. What is the success rate of z-plasty closure procedures for bladder exstrophy in terms of improving cosmetic appearance and function?
  8. Are there any alternative treatment options to consider besides a z-plasty closure for bladder exstrophy?

Reference

Authors: Weiss DA, Steffe E, Borer JG, Groth TW, Roth EB, Kryger JV, Shukla AR, Canning DA, Mitchell ME. Journal: J Pediatr Urol. 2021 Aug;17(4):575-576. doi: 10.1016/j.jpurol.2021.04.011. Epub 2021 Apr 26. PMID: 34006463