Reconstructive Urology Modified VQZ-Plasty for the Creation of a Catheterizable Stoma Suitable as a Neoumbilicus in Selected Bladder Exstrophy Patients Alfredo Berrettini, Waifro Rigamonti, and Marco Castagnetti OBJECTIVE To present a modified VQZ-plasty technique to create a catheterizable stoma appearing as a normal-looking neoumbilicus that may be used in selected bladder exstrophy (BE) patients. METHODS A catheterizable conduit is created according to the Mitrofanoff principle. An asymmetric V flap, with the base at the level selected as the upper margin of the neoumbilicus, is created and incorporated into the spatulated appendix. Then a Q flap is developed parallel to the shorter margin of the V flap, rotated, and anastomosed to the upper edge of the appendix and to the free margin of the V flap on the contralateral side. The skin gap is filled by a rotational flap overlying the emerging appendix and stoma site. RESULTS To date the technique has been used in 2 BE patients. After a follow-up of 10 and 6 months, respectively, both have good cosmetic and functional results, with an easily catheterizable stoma. CONCLUSIONS The described technique allows for the creation of a nearly ideal stoma that looks like a normal neoumbilicus in selected BE patients yet without an umbilicus and requiring the placement of a catheterizable conduit. UROLOGY 72: 1073–1076, 2008. © 2008 Elsevier Inc. B ladder exstrophy (BE) patients can require the creation of a catheterizable conduit to empty their bladder. 1 The umbilicus is generally considered a suitable site for the creation of a concealed stoma. 2 Nev- ertheless, because in BE patients the umbilicus is caudally displaced and attached to the upper margin of the ex- strophied bladder, it is often excised at the time of initial repair. 3 Sumfest and Mitchell 4 first proposed the creation of a neoumbilicus to be used as a catheterizable stoma. An ideal catheterizable stoma should be concealed, avoid skin surface mucosal prolapse, include a V flap to be inserted in the proximal portion of the conduit to avoid stenoses, and have an inlet entirely made of skin to reduce trauma during insertion of the catheter. The VQZ-plasty was devised to fulfill these goals. 5 We present here a modified VQZ technique that may be used in selected BE patients yet without an umbilicus and requiring placement of a catheterizable conduit, to create a catheterizable stoma that appears as a normal- looking neoumbilicus. SURGICAL TECHNIQUE A catheterizable conduit is created according to the Mitrofanoff principle, 6,7 entering the abdomen through a midline suprapubic incision. A broad-based V flap is created in the midline, with the base at the level selected as the upper margin of the neoumbilicus and the apex reaching the cranial end of the midline incision used to enter the abdomen (Fig. 1A). Creation of a slightly asymmetric flap, 1.5 cm longer on one side (Fig. 1B), is recommended. The V flap is incor- porated into the appendix spatulated along its antimes- enteric border (Fig. 1C). A quadrilateral flap (Q flap) is developed next to the shorter margin of the V, with the most cranial portion of the incision slightly bent toward the midline (Fig. 1C). The Q flap is rotated and anasto- mosed to the upper edge of the appendix and to the free margin of the V flap on the contralateral side (Fig. 1D). Such a flap completes the channel, avoids mucosal pro- lapse, and enhances neoumbilical depth. The skin gap is filled by a rotational flap overlying the emerging appendix and stoma site; this is achieved by suturing a point opposite to the most distal part of the Q From the Section of Pediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy Reprint requests: Marco Castagnetti, M.D., Section of Pediatric Urology, Urol- ogy Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Monoblocco Ospedaliero, Via Giustiniani 2, Padua 35128, Italy. E-mail: marcocastagnetti@hotmail.com Submitted: March 26, 2008, accepted (with revisions): June 28, 2008 © 2008 Elsevier Inc. 0090-4295/08/$34.00 1073 All Rights Reserved doi:10.1016/j.urology.2008.06.061