Failed exstrophy closure: Management and outcome

Novak, Thomas E.; Costello, John P.; Orosco, Ryan; Sponseller, Paul D.; Mack, Erin; Gearhart, John P.

doi:10.1016/j.jpurol.2009.10.009

« Previous Next »Journal of Pediatric Urology
Volume 6, Issue 4 , Pages 381-384, August 2010

Failed exstrophy closure: Management and outcome

Thomas E. Novak
- Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Marburg 149, 600 North Wolfe Street, Baltimore, MD 21287, USA
- Corresponding author. Tel.: +1 410 955 5358; fax: +1 410 955 0833.
John P. Costello
- Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Marburg 149, 600 North Wolfe Street, Baltimore, MD 21287, USA
Ryan Orosco
- Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Marburg 149, 600 North Wolfe Street, Baltimore, MD 21287, USA
Paul D. Sponseller
- Division of Pediatric Orthopedics, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
Erin Mack
- Medical College of Georgia, Augusta, GA, USA
John P. Gearhart
- Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Marburg 149, 600 North Wolfe Street, Baltimore, MD 21287, USA

Received 28 May 2009; accepted 16 October 2009. published online 11 November 2009.

Abstract

Objective

In a series of failed exstrophy closures, to identify determinants of successful repeat closure and the impact of failed closure on the fate of the lower urinary tract and continence status.

Patients and methods

We performed a retrospective review of operative notes and medical records of patients with a history of one or more failed exstrophy closures in 1978–2007. The primary surgical endpoints were failure rate of repeat closure attempts, mode of continence surgery and continence outcome. Continence was defined as achieving a dry interval of >3h and voiding through the urethra.

Results

We identified 122 patients (85 male/37 female) who had undergone repeat closure following failure. The success rate of repeat closure attempts at our institution was 98%.

Of the 94 patients who had undergone successful repeat closure, definitive continence management and had their dryness evaluated, 38 were candidates for bladder neck reconstruction and 17(18%) were continent. Of the remaining patients, 90% were able to attain dryness, but at the expense of clean intermittent catheterization and continent urinary diversion.

Conclusion

A failed exstrophy closure has significant implications for long-term surgical outcome. Reclosure can be accomplished in the majority of cases. In comparison to patients with successful primary closure, the rates of urethral continence following successful repeat closure were lower.

Keywords: Bladder exstrophy, Urinary incontinence, Complications