PMC10423616_01
One-stage delayed bladder closure and radical soft-tissue mobilization (Kelly procedure) in a 5-month-old boy with bladder exstrophy repair. (a) Preoperative aspect of the bladder plate and external genitalia. (b) Immediate postoperative results. (c) Aspects of the external genitalia at the 1-month follow-up.
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The penile skin was then re-orientated dorsally to reconstruct the penile skin shaft (Figure 1b). Both esthetic and functional outcomes proved to be excellent also at one month's follow-up (Figure 1c).
Tissue perfusion assessment using the EleVision IR system (Medtronic Ltd) to detect 0.15 mg/kg of ICG intraoperatively administered following i) the mobilization of the bladder plate and the exposure of both corpora (a1 and a2); ii) the mobilization of the left corpus (b1 and b2); the mobilization of both corpora (c1 and c2); the complete detachment of the urethral plate (d1 and d2); the approximation of the pubic symphysis (e1 and e2); the surgical reconstruction (f1 and f2).
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The first perfusion assessment (ICG, 0.15 mg/kg) was performed after the mobilization of the bladder plate and the exposure of both corpora (Figure 2a). The second measurement was performed after the full mobilization of the left corpus (Figure 2b). The third perfusion assessment was performed after the full mobilization of the bladder and both corpora cavernosa (Figure 2c). The following assessment was performed after the separation of the epispadic urethral plate and corpora (Figure 2d). The second-last perfusion assessment was performed at the end of the reconstructive phase (Figure 2e). The last ICG-based perfusion assessment was performed after the neo-urethra was transposed ventrally in a scrotal position, allowing for penile elongation (Figure 2f).