A 4-YEAR-OLD CHILD WAS SAVED FROM A RARE UROLOGICAL PATHOLOGY AT NMITS RADIOLOGY

Bladder exstrophy is a congenital malformation in which the bladder is turned outwards, there is a defect in the anterior abdominal wall, a discrepancy in the bones of the bosom and a shortened penis.

If the child has an initially large bladder, surgery can be performed in the first weeks or months of life and maximise the child’s normal urinary retention. However, in the case of our patient, things turned out differently.

A 4-year-old boy from Bryansk was born with a very small bladder (less than 3 cm), which made it impossible to create a reservoir for urine accumulation. When patients try to close such a small bladder, complications often occur: the wounds separate and the bladder comes out again.

According to statistics, 1 child per 50,000 is born with exstrophy, which makes this pathology extremely rare. Therefore, doctors from the boy’s hometown sent him to the professor Y.E. Rudin, a surgeon with the most extensive experience in performing operations for pediatric exstrophy in Russia, Head of the Pediatric Urology Group of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology (SRIUIR) – the branch of the FSBI “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation.

Doctors of N. Lopatkin SRIUIR performed an operation to increase the size of the bladder. He was injected with botulinum toxin to create conditions for relaxation of the bladder muscles and gradual stretching.

“We spent a year and a half expanding the bladder until it reached a size of 56cm, after which we performed bladder closure surgery, reimplantation of the ureter, created a bladder neck and brought the bosom bones together after a pelvic bone osteotomy. It was a very complex and difficult operation, but necessary,” Prof. Rudin shared.

After the bladder expansion was achieved and the wounds healed, the surgeons started the penis correction. At the last stage, Yuri Edvartovich together with Georgiy Vladimirovich Lagutin, a researcher from the Pediatric Urology Group, performed an operation to increase the size of the penis, separated the cavernous bodies from the bosom bones, eliminated the curvature and created a urethra for the boy.

The operation was successful. Now we are monitoring the little patient, making sure that he heals well and retains urine after the surgery. In 23 weeks, the child will recover, and the surgeons at NMRRC of the Ministry of Health of the Russian Federation hope that the bladder will continue to grow and the child will be as socially adapted as possible.