Modern staged repair of bladder exstrophy: A contemporary series

Baird, A.D.; Nelson, C.P.; Gearhart, J.P.

doi:10.1016/j.jpurol.2006.09.009

« Previous Next »Journal of Pediatric Urology
Volume 3, Issue 4 , Pages 311-315, August 2007

Modern staged repair of bladder exstrophy: A contemporary series

A.D. Baird
- Division of Pediatric Urology, Brady Urological Institute, Marburg 146, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
- Department of Urology, Royal Liverpool University Hospital, Prescot Street, Merseyside, Liverpool L7 8XP, UK
- Corresponding author. Division of Pediatric Urology, Brady Urological Institute, Marburg 146, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA. Tel.: +1 410 955 5358; fax: +1 410 955 0833.
- Tel.: +1 44 151 706 2000.
C.P. Nelson
- Division of Pediatric Urology, Brady Urological Institute, Marburg 146, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
J.P. Gearhart
- Division of Pediatric Urology, Brady Urological Institute, Marburg 146, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA

Received 11 September 2006; accepted 28 September 2006. published online 28 December 2006.

Abstract

Objective

Many changes have occurred in the treatment of bladder exstrophy over the last few years and many repairs are now offered. The purpose of this study was to evaluate long-term outcomes in a select group of patients in whom modern staged repair (MSRE) was undertaken.

Patients and methods

From an institutionally approved database were extracted 189 patients who had undergone primary closure between 1988 and 2004. The records of 131 patients (95 males) who underwent MSRE with a modified Cantwell-Ransley repair by a single surgeon in 1988–2004 were reviewed with a minimum 5-year follow up.

Results

Sixty-seven patients with a mean age of 2months (range 6 h to 4months) underwent primary closure, and 18 underwent osteotomy at the same time. Mean age at epispadias repair was 18months (8–24). Mean age at bladder neck reconstruction (BNR) was 4.8years (40–60months) with a mean capacity of 98cc (75–185). Analysis of bladder capacity prior to BNR revealed that patients with a mean capacity greater than 85cc median had better outcomes. Seventy percent (n=47) are continent day and night and voiding per urethra without augmentation or intermittent catheterization. Social continence defined as dry for more than 3h during the day was found in 10% (n=7). Six patients required continent diversion after failed BNR. Seven patients are completely incontinent. The mean time to daytime continence was 14months (4–23) and the mean time to night-time continence was 23months (11–34). No correlation was found between age at BNR and continence.

Conclusions

Patients with a good bladder template who develop sufficient bladder capacity after successful primary closure and epispadias repair can achieve acceptable continence without bladder augmentation and intermittent catheterization.

Keywords: Bladder exstrophy, Staged repair, Reconstruction