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 from the specialists at Ichilov Clinic, patients gain access to the most effective treatment strategies. All conditions are created here for a successful fight against the disease, 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 various 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 the 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. That is, the bladder is somewhat located 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 that appears as a red or pink area in the lower abdomen, from which urine continuously flows. Additionally, changes in the structure of the genital organs (they do not look as usual) may often be noticeable, and the pelvic bones are generally positioned wider than normal. In some cases, exstrophy may be suspected even before birth during routine ultrasound examinations.
Treatment Methods for Bladder Exstrophy
The choice of treatment methods for bladder exstrophy depends on the severity of the defect, the age of the patient, and the anatomical features of the defect. 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 the simultaneous closure of the bladder, reconstruction of the urethra, and correction of epispadias. Modern suture materials with prolonged biodegradation and multilayer suturing techniques are used. The method ensures the achievement of anatomical correction of all components of the defect in one operation.
Kelly Procedure
A classic staged surgical technique used from the first months of life, including 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. The 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 is distinguished depending on the size of the defect. The method reduces tissue tension when closing the defect and improves conditions for healing.
Epispadioplasty
Epispadioplasty is a specialized surgical technique used to correct 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. The method allows for anatomical correction and restoration of normal urination function.
Bladder Neck Plasty
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 applied depending on anatomical features. It ensures the formation of continence and prevention of urine reflux.
Augmentation Cystoplasty
A reconstructive technique used in cases of small bladder capacity after primary correction. The technology involves the use of segments of the intestine, 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. The 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, considering the sensitivity of the microflora. Prophylactic administration is carried out one hour before surgery, continuing into the early postoperative period. The 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 involves maintaining 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.
Physiotherapy Methods
A complex of rehabilitation activities used in the recovery period after surgical correction. Technologies of 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. The method promotes the restoration of muscle tone and improves functional results of surgical treatment.
Diagnostic Methods for the Disease
All diagnostic procedures for the treatment of bladder exstrophy at 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 collects a detailed medical history, conducts a clinical examination, analyzes the provided documents, and assigns 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 analysis
- bladder ultrasound
- urocystography
- excretory urography
- MRI of the pelvic organs
- CT of the abdominal organs
- pelvic X-ray
- functional tests of the bladder
Third Day
After completing the examination, 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 the effectiveness of therapy and reduces the risks of complications.
- Computed Tomography
- Magnetic Resonance Imaging (MRI)
- X-ray
- Ultrasound
- Blood Biochemistry
How Much Does Treatment Cost in Israel
The calculation of treatment costs is always an individual process that depends on many factors to match the needs of each patient as accurately as possible. 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 narrow 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 the 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 invasiveness.
- Management of patients by highly qualified urologists with international practice and experience in complex reconstructive surgeries.
- Utilization of the latest diagnostic and surgical equipment for precise planning and safe conduct of interventions.
- A 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 order an online consultation with a specialist. This will provide recommendations, answers to questions, and confidence in the correctness of the treatment choice.