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Case Reports
. 2018 Nov 8;16(4):eRC3887.
doi: 10.31744/einstein_journal/2018RC3887.

Late secondary urological reconstruction of separated ischiopagus twins with exstrophic bladder and urinary incontinence

[Article in English, Portuguese]
Antonio Macedo Jr  1   2 , Marcela Leal da Cruz  1
Affiliations
Case Reports

Late secondary urological reconstruction of separated ischiopagus twins with exstrophic bladder and urinary incontinence

[Article in English, Portuguese]
Antonio Macedo Jr et al. Einstein (Sao Paulo). .

Abstract
in English, Portuguese

We report a case of secondary urinary reconstruction of previously separated conjoined twins with exstrophic bladder and urinary incontinence. Patients were male and aged 13-year-old. Twin one had a history of failed enterocystoplasty that extruded and was visible like an exstrophic neobladder. He underwent a procedure to close bladder neck and reconfigure abdominal wall. After the procedure the patient developed a fistula that was treated, but it persisted and, for this reason, a catheterizable pouch was constructed and native bladder was discarded. Twin two required the immediately construction of catheterizable pouch using the Macedo's technique. Currently, both patients are continent at 4 hour intervals. The mean follow-up was 8 months. Modern continent urinary diversion techniques offer new perspectives and hope for such complex population.

Relata-se caso de reconstrução urinária em gêmeos siameses previamente separados com apresentação clínica de bexiga extrófica e incontinência urinária. Os dois pacientes eram do sexo masculino com idade de 13 anos. O primeiro gêmeo apresentava falha da enterocistoplastia com extrusão e visualização da neobexiga extrófica, tendo sido submetido ao fechamento do colo vesical e à reconfiguração da parede abdominal. Após o procedimento, o paciente desenvolveu fístula, que foi tratada, mas persistiu. Posteriormente, optamos por bolsa cateterizável, descartando a bexiga nativa. O segundo gêmeo foi submetido à construção imediata de bolsa cateterizável, por meio da técnica de Macedo. Atualmente, ambos os pacientes estão continentes em intervalos de 4 horas. O seguimento médio foi de 8 meses. As atuais técnicas de derivação urinária oferecem novas perspectivas e esperança para esta população complexa.

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Figures

Figure 1
Figure 1. Male tetrapus twins joined from lower abdomen to perineum
Figure 2
Figure 2. Visible neobladder in right lower abdominal quadrant, urinary stoma upwards, and open communication of bladder with penis
Figure 3
Figure 3. Fistula closure and epispadia repair
Figure 4
Figure 4. Construction of a pouch with additional ileum segment and use of appendix as outlet channel
Figure 5
Figure 5. Immediately construction of a pouch using Macedo’s technique and discarding of native bladder
See this image and copyright information in PMC

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