METHOD FOR SURGICAL TREATMENT OF MICROCYSTIS IN CHILDREN WITH BLADDER EXTROPHY AT THE STAGE OF PREPARATION FOR DELAYED PRIMARY CLOSURE Russian patent published in 2023 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatric urology. Mucosal polyps at the base of the protrusion are excised with a coagulator, hemostasis is performed, and the mucosal defect is sutured with an interrupted 5/0 vicryl suture. Further, along the edge of the bladder site, at 10, 12 and 2 o'clock position, the skin is cut in the radial direction in the area of the transition of the bladder mucosa to the skin of the anterior abdominal wall for 1.5 cm. Then the aponeurosis of the external oblique muscles of the abdomen is dissected, and under the control of the finger inserted into the cavity of the small pelvis, the bladder is immersed inward and the opening of the aponeurosis is further expanded with the help of two fingers, achieving maximum mobility of the bladder wall, the pressure on the upper and lateral surfaces of the anterior abdominal wall is checked and if the bladder comes out when pressed, filled with intestinal loops from the inside, the desired effect is achieved. After that, the holes in the aponeurosis are sutured with single 4/0 vicryl in the longitudinal direction and the skin is sutured with 5/0 vicryl. Next, reimplantation of the ureters is performed according to the Cohen method, the mouth is taken on a holder, a ureteral catheter 5 CH is installed and fixed to the holder with an interrupted suture. Then, the mouth of the ureter is isolated with a fringing incision and mobilized from the surrounding tissues for 3 cm, a submucosal tunnel is formed, directed upwards to the umbilical region 3 cm long, through which the ureter is passed along with the catheter, the mouths are formed with interrupted vicryl 5\0 sutures, the ureteral catheter is fixed to the bladder mucosa, after which a similar operation is performed with another ureter. Next, the holes in the bladder and sutured tightly in layers. Injections are made to the bladder wall in 10 points, in accordance with the scheme shown in Figure 5 - 1 ml of the botulinum toxoid type A solution 50 IU in 10 ml of saline. The ureteral drainage tubes are removed in 4 weeks, and 1 month after the surgery, mechanical stretching of the bladder is started: the bladder is gradually immersed with a finger into the small pelvis 2 times a day for 5 minutes, in 1 month, a Foley catheter with an inflated balloon is installed into the bladder instead of the finger and held the catheter starting with 5 minutes, increasing the duration to 10 minutes. The volume of fluid injected into the Foley catheter balloon is also gradually increased from 5 ml to 10 ml and 15 ml, and when the bladder wall is stretched to 5-6 cm, a delayed primary closure of the bladder is performed with neck plastic surgery.

EFFECT: method allows to excise all polypous growths protruding on the surface of the bladder mucosa and make it smooth; increase the size of the opening in the aponeurosis of the anterior abdominal wall for a free inward and outward movement of the bladder, due to this, any tension in the anterior abdominal wall fills the bladder with intestinal loops and squeezes out the bladder and helps to stretch gradually it, like when it is filled with urine; create an anti-reflux mechanism to prevent urinary reflux after primary bladder closure and increase the distance between the orifices and seminal tubercle to allow for a longer bladder neck during delayed primary closure; relieve bladder muscle spasm and enhance the effect of bladder distension.

1 cl, 9 dwg, 2 ex