Summary
Objectives
Complete primary repair of exstrophy (CPRE) was established as a method to reduce
numbers of procedures for the reconstruction of bladder exstrophy (BE). Performed
since 1989, some suggest it as a replacement for the staged reconstructive procedure,
the gold standard. Does CPRE reduce the numbers of procedures for reconstruction of
BE?
Methods
Literature was reviewed from 1989 to 2016, and articles evaluating outcomes of patients
undergoing CPRE, extracted. Effort was made to obtain final data from each reporting
institution/group. Eleven articles meeting criteria were evaluated for qualitative
systematic review. Age at initial closure, complications, additional procedures, and
outcomes were evaluated to provide an overview of CPRE.
Results
Ten groups reported BE management using the CPRE technique. 236 patients (153 boys;
72 girls; 11 unknown sex) had primary closure ranging from birth to 5.6 years. Osteotomy
was favored by most in infants closed beyond the first 72 h of life along with spica
cast immobilization. Three groups recommended concomitant augmentation for infants
with small bladder capacities. Ureteral reimplantation was required in 58 patients
with recurrent urinary tract infections resistant to prophylaxis. Hypospadias repair
was required for most boys having complete penile disassembly, and most children eventually
required bladder neck reconstruction (BNR) for continence. Overall, voiding without
BNR was noted in 16–37% of children in the reported series.
Conclusions
Complete primary repair of exstrophy has been suggested as a single procedure for
the management of BE. Literature review suggests most patients require multiple procedures
to complete reconstruction and attain continence.
Keywords
Abbreviations:
BE (bladder exstrophy), BNR (bladder neck reconstruction), BUR (bilateral ureteral reimplantation), CIC (clean intermittent catheterization), CPRE (complete primary repair of bladder exstrophy), MSRE (modern staged repair of bladder exstrophy), SRP (staged reconstructive procedure), VUR (vesicoureteral reflux)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 14, 2020
Accepted:
January 7,
2020
Received:
February 8,
2019
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
