Summary
Introduction
Historically, repair of bladder exstrophy (BE) is associated with compromise to the
upper tracts; the single stage repair of BE was considered to exacerbate risks of
kidney impairment.
Objective
We aim to evaluate the risk of upper urinary tract deterioration or chronic kidney
disease after the complete primary repair of exstrophy (CPRE).
Study design
As part of the U.S.-India Multi-institutional Bladder Exstrophy Collaboration, we
prospectively performed data collection on all patients managed at the Civil Hospital,
Ahmedabad from 2010 to 2020. All patients who underwent primary or redo BE or primary
penopubic epispadias (PE) repair using CPRE were included. Data on annual VCUG and
DMSA, serum creatinine and cystatin-C, urinary albumin, and creatinine were aggregated.
Results
72/104 patients who underwent CPRE at a median age of 1.7 years (IQR: 1.1–4.6) were
included: 43(60%) patients with primary BE, 17(24%) with redo BE, and 12(17%) with
primary PE. At a median follow-up of 4 years (IQR: 3–6), the overall median eGFR was
105 for BE, and 128 ml/min for PE. 14(19%) patients had eGFR<90, and 22(31%) had microalbuminuria.
21(30%) patients had kidney scarring in DMSA and 31(44%) had VUR. Multivariate analysis
showed that neither kidney scarring nor VUR could predict the presence of eGFR<90
or microalbuminuria.
Of 72 patients, 2 (3%) patients had dry intervals >3 h, 9 (13%) patients have dry
intervals of 1–3 h and 44 (61%) patients had dry intervals <1 h during follow-up.
We found that kidney function outcomes (i.e., eGFR and microalbuminuria) were not
associated with continence status (p = 0.3).
Discussion
In this series, we report a 5% incidence of CKD stage 2 or above that was not impacted
by continence status. Furthermore, a 40% incidence of VUR and a 30% incidence of kidney
scarring during follow-up was observed within this cohort, neither of which had a
significant impact on renal function deterioration (i.e, decline in eGFR), but underscores
the need for close kidney surveillance in children that have undergone bladder exstrophy
repair.
Conclusions
Summary Table
| Factor | Primary BE | Redo BE | p-value | Epispadias |
|---|---|---|---|---|
| N | 43 | 17 | 12 | |
| Gender, No (%) | ||||
| Female | 11 (26%) | 5 (29%) | 0.76 | 3 (25%) |
| Male | 32 (74%) | 12 (71%) | 9 (75%) | |
| Current age (y), Median (IQR) | 6.3 (4.6, 8.2) | 12.4 (6.7, 14.3) | <0.001 | 9.3 (6.1, 13.8) |
| Age at initial surgery (y), Median (IQR) | 1.3(0.7,1.8) | 8.05 (2.8,10.4) | <0.001 | 3.9 (2.0, 5.7) |
| eGFR, Median (IQR) | 125 (111.5, 139.9) | 120.5 (110.4, 131) | 0.61 | 136.6 (110.2, 155.5) |
| GFR<90 | 1 (2.4%) | 3 (18%) | 0.25 | 0 (0%) |
| Normal (90–120) | 14 (33%) | 5 (29%) | 4 (40%) | |
| Hyperfiltration (>120) | 27 (64%) | 9 (53%) | 6 (60%) | |
| Unilateral VUR | 2 (5%) | 1 (7%) | 0.62 | 0 (0%) |
| Bilateral VUR | 19 (44%) | 8 (53%) | 1 (8%) | |
| Bladder capacity (cc), Median (IQR) | 40 (30, 100) | 50 (20, 100) | 0.80 | 95 (62.5, 175) |
| Kidney scarring, No (%) | 14 (34%) | 6 (35%) | 1.00 | 1 (9%) |
| Δ DRF, Median (IQR) | 7 (3.2, 16) | 10 (4, 24) | 0.26 | 4 (.3, 8) |
| <10% | 24 (57%) | 7 (41%) | 0.12 | 9 (82%) |
| 10–20% | 13 (31%) | 4 (24%) | 2 (18%) | |
| >20% | 5 (12%) | 6 (35%) | 0 (0%) | |
| Annual follow-up from surgery (y), Median (IQR) | 4 (3, 6) | 3 (2, 5) | 0.078 | 3 (3, 4) |
Keywords
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Article info
Publication history
Published online: April 29, 2022
Accepted:
April 23,
2022
Received in revised form:
April 13,
2022
Received:
December 4,
2021
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
