Professor Jack Banielleading urological surgeon
Bladder exstrophy is a complex congenital condition; however, modern approaches practiced in Israel promise encouraging prospects. Thanks to years of experience, advanced medical technologies, and the highest level of expertise of the specialists at the Ichilov clinic, patients have access to the most effective treatment strategies. All conditions are created for successful disease management, and each stage of therapy is carefully planned to achieve the best outcome.
It is at Ichilov that the most modern treatment protocols are applied, and the therapy plan is always formulated individually, taking into account all the specifics of the patient's condition. A multidisciplinary approach combines the efforts of doctors from different specialties, ensuring rapid and accurate diagnosis, as well as a comprehensive analysis of the problem. This team approach allows for high effectiveness even in the most complex cases, significantly improving quality of life and providing hope for complete recovery.
About the Disease
Bladder exstrophy forms very early, during the first weeks of intrauterine development. It occurs because the bladder and the skin that should cover it do not develop fully and remain open. In other words, the bladder is positioned outside the body, on the anterior abdominal wall. It is important to understand that this is not related to anything the future mother did wrong during pregnancy; it is simply a complex and usually random developmental error of the fetus.
This condition can be noticed immediately at birth. The main symptom indicating bladder exstrophy is an open, visible bladder, which appears as a red or pink area in the lower abdomen, from which urine continuously leaks. Additionally, changes in the structure of the genital organs may often be noticeable (they do not look as usual), and the pelvic bones are generally positioned wider than normal. In some cases, exstrophy may be suspected even before birth during routine ultrasound examinations.
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Treatment Methods for Bladder Exstrophy
The choice of treatment methods for bladder exstrophy depends on the severity of the defect, the patient's age, and the anatomical features of the defect. The modern strategy often involves a staged combined approach using surgical and conservative methods to achieve functional reconstruction of the urogenital system.
CPRE (Complete Primary Repair of Exstrophy)
A modern one-stage surgical technique performed within the first 72 hours of the newborn's life for complete correction of bladder exstrophy. The technology includes the use of microsurgical instruments, operating loupes for magnification, and specialized retractors for simultaneous closure of the bladder, urethral reconstruction, and correction of epispadias. Modern suture materials with prolonged biodegradation and multilayer suturing techniques are used. This method ensures anatomical correction of all components of the defect in one operation.
Kelly Procedure
A classical staged surgical technique used from the first months of life, involving three sequential stages of correction. The first stage involves closing the bladder using detrusor mobilization technique and reservoir formation. The second stage includes anti-reflux reimplantation of the ureters using submucosal tunneling. The third stage represents epispadioplasty with urethral reconstruction. This technology ensures staged restoration of anatomy while minimizing surgical trauma at each stage of treatment.
Pelvic Bone Osteotomy
An orthopedic method used simultaneously with bladder reconstruction to facilitate the closure of the defect edges. The technology involves the use of special osteotomes and fixation systems to perform controlled fractures of the iliac bones. Unilateral and bilateral osteotomy are distinguished depending on the size of the defect. This method reduces tissue tension when closing the defect and improves conditions for healing.
Epispadioplasty
Epispadioplasty is a specialized surgical technique used for the correction of epispadias. Microsurgical techniques with optical magnification are used for precise reconstruction of the urethra and corpora cavernosa. The Cantwell-Ransley technique or a modified Mitchell technique is performed depending on the degree of penile curvature. This method allows for anatomical correction and restoration of normal urination function.
Bladder Neck Plastic Surgery
A reconstructive operation performed in a delayed period in cases of sphincter insufficiency after primary reconstruction. The technology includes the use of autotransplants from the detrusor or synthetic materials to create an anti-reflux mechanism. Techniques by Yang-Diss-Lidbetter or Cohen modification are used depending on the anatomical features. This ensures the formation of continence and prevention of urine reflux.
Augmentation Cystoplasty
A reconstructive technique used for small bladder capacity after primary correction. The technology involves the use of intestinal segments, most often the ileum, to increase the volume of the reservoir. It is performed using stapler technologies and microsurgical anastomoses to create low pressure in the reservoir. This method ensures adequate bladder capacity and improves functional treatment outcomes.
Antibiotic Therapy
A conservative method used in the perioperative period and in the development of infectious complications. Third-generation cephalosporins or protected penicillins are used, taking into account the sensitivity of the microflora. Prophylactic administration is performed one hour before surgery and continues in the early postoperative period. This method prevents purulent-septic complications and creates favorable conditions for tissue healing.
Bladder Catheterization
An auxiliary drainage method used in the postoperative period to ensure adequate urine outflow. Silicone catheters of various diameters with balloon fixation or special stents are used. The technology requires adherence to aseptic conditions and regular sanitation of the drainage system. The duration of drainage is from two to four weeks, depending on the volume of intervention and the speed of tissue healing.
Physiotherapeutic Methods
A complex of rehabilitation measures used in the recovery period after surgical correction. Technologies for pelvic floor muscle electrical stimulation, ultrasound therapy, and laser exposure are used to improve tissue trophism. It includes special exercises to strengthen the sphincter apparatus and biological feedback. This method contributes to the restoration of muscle tone and improves functional outcomes of surgical treatment.
Diagnostic Methods for the Disease
All diagnostic procedures for the treatment of bladder exstrophy at the Ichilov clinic are planned in advance and are usually conducted within three days. This approach allows for a quick and accurate clinical picture and enables prompt selection of the optimal therapeutic strategy.
First Day
On the day of arrival, the patient undergoes a consultation with the attending physician. The doctor thoroughly collects the medical history, conducts a clinical examination, analyzes the provided documents, and prescribes necessary diagnostic studies to assess the patient's condition as fully as possible.
Second Day
On the second day, the patient undergoes a comprehensive examination, including laboratory and instrumental diagnostic methods:
- complete blood count
- biochemical blood analysis
- urinalysis
- electrolyte analysis
- kidney function tests
- bladder ultrasound
- urocystography
- excretory urography
- pelvic MRI
- abdominal CT
- pelvic X-ray
- functional bladder tests
Third Day
After the examination is completed, the doctors conduct an interdisciplinary consultation. The discussion involves a urologist, pediatric or adult surgeon, nephrologist, as well as an anesthesiologist and specialists in reconstructive surgery. This collaborative approach ensures accurate diagnosis and the development of an individual treatment plan, which enhances therapy effectiveness and reduces complication risks.
- Computed Tomography
- Magnetic Resonance Imaging (MRI)
- X-ray
- Ultrasound
- Blood Biochemistry
What is the Cost of Treatment in Israel
The calculation of treatment costs is always an individual process that depends on many factors to accurately meet the needs of each patient. The price is formed based on the complexity of the specific case, the patient's age, the volume of necessary surgery, as well as the duration of hospitalization and rehabilitation. The need for additional examinations, consultations with specialists, and the use of specific medications is also taken into account. All these details are carefully analyzed to create a personalized financial plan.
To obtain an accurate cost estimate that corresponds to your unique situation, we recommend contacting our consultant at the phone number provided on the website. The consultant will answer all your questions in detail, clarify the stages of treatment, and most importantly, provide complete information about the expected costs based on a preliminary assessment of the medical documents you provide. This will allow you to plan your budget in advance and make an informed decision.
Advantages of Treatment in Israel
- Use of advanced surgical techniques, including CPRE and the Kelly procedure, ensuring maximum effectiveness and minimal trauma.
- Management of patients by highly qualified urologists with international practice and experience in complex reconstructive surgeries.
- Use of the latest diagnostic and surgical equipment for precise planning and safe conduct of interventions.
- Comprehensive multidisciplinary approach involving specialists in nephrology and orthopedics for a thorough solution to the problem.
- Individually tailored postoperative recovery programs with subsequent long-term monitoring and support at all stages of rehabilitation.
Before arriving at the Israeli clinic, the patient can request an online consultation with a specialist. This will provide recommendations, answers to questions, and confidence in the correctness of the treatment choice.