Can the modified Heitz-Boyer-Hovelacque rectal bladder technique be used as a rescue method in patients with bladder exstrophy?

Bladder exstrophy is a rare and severe congenital anomaly of an open bladder and urethral sphincter deficiency. Some of these children continue to live with urinary incontinence despite reconstructive surgery performed in specialized centers. This study aimed to present the results of the modified Heitz-Boyer-Hovelacque rectal bladder technique in patients with previous unsuccessful reoperation. Our study included two female and one male foreign patient who had previously undergone unsuccessful surgery. These patients had scarred, low capacity, contracted, and collapsed open bladders. All surgical procedures, including those requiring clean intermittent catheterization as a salvage operation, were explained to the patients and their families. The modified Heitz-Boyer-Hovelacque rectal bladder technique, which is thought to provide the highest level of continence in a single operation, was applied to patients at the request of their families. No complications were observed in our patients in the early postoperative period. At the end of the 2-year follow-up, patients with normal blood electrolyte values underwent proctoscopic biopsy protocol and no neoplastic or metaplastic changes were found. The modified Heitz-Boyer-Hovelacque rectal bladder technique is considered a convenient and straightforward one-stage surgical technique for patients with bladder exstrophy who have previously undergone unsuccessful surgery abroad. Considering the minimal mixing of urine and feces in the rectum, the risk of rectal neoplasia seems to be much lower than with ureterosigmoidostomy. However, they should be followed up with proctoscopy-biopsy in the long term.