CC BY-NC-ND 4.0 · Indian J Plast Surg 2011; 44(03): 444-447
DOI: 10.1055/s-0039-1699517
Original Article
Association of Plastic Surgeons of India

Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap

P. Agarwal
Plastic Surgery Unit, Department of Surgery, N.S.C.B. Government Medical College, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Further Information

Publication History

Publication Date:
31 December 2019 (online)


Background: The aim of this study was to investigate the efficacy of the rectus abdominis myo-peritoneal flap (RAMP) technique for the closure and augmentation of small, non-elastic, non-compliant bladder exstrophies. Materials and Methods: The RAMP technique was used in three boys with bladder exstrophy who presented late with small, non-elastic, non-compliant bladder. The clinical outcome, imaging, cystoscopy, biochemical and microbiological studies were assessed during a follow-up of 36 months. Results: Bladder closure and augmentation was achieved in all patients without any complications. There were no urinary tract infections, metabolic problems or electrolyte disturbances and the kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMP with uroepithelium. No stone formation or mucous production was detected. Conclusions: The RAMP technique is a good alternative for closing bladder exstrophies and achieves an increase in bladder capacity and compliance. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures.


  • 1 Rickham PP. The Incidence and Treatment of Ectopia Vesicæ [Abridged] Proc R Soc Med 1961;54:389-92.
  • 2 Buyukunal SN, Kaner G, Celayir S. An alternative treatment modality in closing bladder exstrophy: Use of rectus abdominis muscle flap--preliminary results in a rat model. J Pediatr Surg 1989;24:586-9.
  • 3 Kilic N, Celayir S, Elicevik M, Sarimurat N, Soylet Y, Buyukunal C, et al. Bladder augmentation: Urodynamic findings and clinical outcome in different augmentation techniques. Eur J Pediatr Surg 1999;9:29-32.
  • 4 Gearhart JP. Bladder and urechal abnormalities: The exstrophy-epispadias complex. In: Clinical pediatric urology. 3rd ed. Kelalis PP, King LR, Belman AB, editors. Vol. 1, Chapt. 15. Philadelphia: WB Saunders Co; 1992. p. 579-619.
  • 5 Sanni-Bankole R, Masson J, Di Benedetto V, Coquet M, Monfort G. Gastrocystoplasty in the treatment of bladder exstrophy. Eur J Pediatr Surg 1995;5:342-7.
  • 6 Pinter AB, Vajda P, Juhasz Z. Bladder augmentation in childhood: Metabolic consequences and surgical complications - review and own investigations. J Pediatr Surg Spec 2008;2:62-7.
  • 7 Perovic SV, Djordjevic ML, Kekic ZK, Vukadinovic VM. Bladder autoaugmentation with rectus muscle backing. J Urol 2002;168:1877-80.
  • 8 Erol A, Ozgur S, Erol U, Ozgur F, Akman Y, Ozguven V, et al. Partial bladder reconstruction with pedicled rectus and gracilis muscle flaps: An experimental study in dogs. Br J Urol 1994;74:775-8.
  • 9 Bellinger MF. Ureterocystoplasty: A unique method for vesical augmentation in children. J Urol 1993; 149:811-3.
  • 10 Celayir S, Kilic N, Dervisoglu S, Buyukunal C. Rectus abdominis muscle flap technique for the management of large bladder defects: Urodynamic findings in a rabbit model. Br J Urol 1996; 78:294-7.
  • 11 Sadove RC, Rodgers JB, Fink BF, McRoberts JW. Experimental rectus abdominis myocutaneous and rectus abdominis myoperitoneal flaps as urinary bladder wall substitutes in miniature swine. Plast Reconstr Surg 1993; 91:511-21.
  • 12 Pien SA, Schwencke-König J, Hage J, Kon M. Comparison of rectus abdominis muscle and musculoperitoneal flap in closure of urinary bladder defects in a rat model. Eur J Plast Surg 0 2004; 27:233-7.
  • 13 Wu CW, Lin CH, Lin CH. One-stage posttraumatic bladder reconstruction and soft-tissue coverage of the lower abdomen or perineum. Ann Plast Surg 2010; 64:65-8.
  • 14 Buyukunal SN. Interim report in humans of a previously described technique in an animal model: Closure of bladder exstrophy with rectus abdominis muscle flap-II. J Urol 1994; 152:706-9.