Summary
Introduction
The authors aim to compare single institutional 30-day complication rates between
delayed and neonatal closure of classic bladder exstrophy (CBE).
Materials and methods
An institutional database of 1415 exstrophy-epispadias patients was reviewed retrospectively
for CBE patients who underwent primary closures at the authors' institution between
1990 and 2020. Patients were identified as having received either neonatal or delayed
(at age >28 days) closures. All 30-day complications were recorded, including wound
infection and dehiscence, genitourinary and non-genitourinary infections, bowel obstruction,
blood transfusions, and others. Descriptive statistics were performed to summarize
patient level data. Categorical variables were reported by count and percentages and
were compared using Exact Cochran-Armitage trend analysis by decade, or with Fisher's
Exact Test and Chi-square test when directly comparing categories and outcomes. Continuous
variables were analyzed via Mann Whitney U and one-way ANOVA as appropriate.
Results
The cohort included 145 patients: 50 delayed and 95 neonatal closures. The total complication
rate was 58% in delayed closures compared to 48.4% for neonatal closures (p = 0.298), with the majority being Clavien-Dindo grade I or II. Excluding blood transfusion,
complication rates fell to 26% and 34.7% in delayed and neonatal closures, respectively
(p = 0.349). The most common single complication was unplanned post-operative blood
transfusion (38% delayed; 26.3% neonatal; p = 0.34), followed by pyelonephritis (2% delayed; 8.4% neonatal), and urinary fistula
(6% delayed; 1.1% neonatal). Grade III Clavien-Dindo complications occurred in 2%
delayed and 7.4% neonatal groups (n = 1; n = 7 respectively; p = 0.263). A single delayed patient had grade IV complications compared to three neonatal
patients (p = 0.66).
Conclusions
Summary Table30-day post-operative complications.
| Variable, n (%) | Neonatal | Delayed | P |
|---|---|---|---|
| Any complication | 46 (48.4%) | 29 (58%) | 0.298 |
| Complication w/o Transfusion | 33 (34.7%) | 13 (26%) | 0.349 |
| Clavien I-II complications | 40 (42.1%) | 27 (54%) | 0.292 |
| Wound dehiscence | 2 (2.1%) | ∼ | |
| Wound infection | 1 (1%) | 1 (2%) | |
| Febrile UTI | 5 (5.3%) | 1 (2%) | |
| Pyelonephritis | 8 (8.4%) | 1 (2%) | |
| Urinary fistula | 1 (1%) | 3 (6%) | |
| Non-GU infection | 2 (2.1%) | 3 (6%) | |
| Other | 5 (5.3%) | 2 (4%) | |
| Post-operative Transfusion | 25 (26.3%) | 19 (38%) | 0.34 |
| Clavien III complications | 7 (7.4%) | 1 (2%) | 0.263 |
| Wound dehiscence | 3 (3.2%) | ∼ | |
| Wound infection | ∼ | ∼ | |
| Urinary fistula | ∼ | ∼ | |
| Bowel obstruction | ∼ | 1 (2%) | |
| Non-GU infection | 1 (1%) | ∼ | |
| Other | 3 (3.2%) | ∼ | |
| Clavien IV complications | 3 (3.2%) | 1 (2%) | 1 |
| Non-GU infection | 1 (1%) | 1 (2%) | |
| Other | 2 (2%) | ∼ |
Keywords
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References
- Advances in pediatric urology which have affected the management of bladder exstrophy.Nihon Hinyokika Gakkai Zasshi. 1995; 86: 11-12https://doi.org/10.5980/jpnjurol.86.11
- The factors in successful exstrophy closure.J Urol. 1982; 127: 974-976https://doi.org/10.1016/s0022-5347(17)54151-8
- Complete primary closure of bladder exstrophy. Epispadias and bladder exstrophy repair.Urol Clin. 1999; 26: 95-109https://doi.org/10.1016/s0094-0143(99)80009-3
- Delayed primary closure of bladder exstrophy without osteotomy: 12 year experience in a safe and gentle alternative to neonatal surgery.J Pediatr Surg. 2022; 57: 303-308https://doi.org/10.1016/j.jpedsurg.2021.12.017
- Osteotomy in the newborn classic bladder exstrophy patient: a comparative study.J Pediatr Urol. 2021; 17: 482.e1-482.e6https://doi.org/10.1016/j.jpurol.2021.04.009
- Short-term outcomes of the multi-institutional bladder exstrophy consortium: successes and complications in the first two years of collaboration.J Pediatr Urol. 2017; 13: 275.e1-275.e6https://doi.org/10.1016/j.jpurol.2017.01.006
- Early versus delayed closure of bladder exstrophy: a national surgical quality improvement Program pediatric analysis.J Pediatr Urol. 2018; 14: 27.e1-27.e5https://doi.org/10.1016/j.jpurol.2017.11.008
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213https://doi.org/10.1097/01.sla.0000133083.54934.ae
- Surgical treatment of exstrophy of the bladder with emphasis on neonatal primary closure: personal experience with 28 consecutive cases treated at the University of Washington Hospitals from 1962 to 1977: techniques and results.J Urol. 2002; 168 (1979 discussion 217-219): 214-217
- Long-term followup of 207 patients with bladder exstrophy: an evolution in treatment.J Urol. 1989; 142 (discussion 795-796 https://doi.org/10.1016/s0022-5347(17)38890-0): 793-795
- One-stage combined delayed bladder closure with Kelly radical soft-tissue mobilization in bladder exstrophy: preliminary results.J Pediatr Urol. 2018; 14: 558-564https://doi.org/10.1016/j.jpurol.2018.07.013
- Delayed primary repair of bladder exstrophy: ultimate effect on growth.J Urol. 2012; 188: 2336-2341https://doi.org/10.1016/j.juro.2012.08.037
- Complications of surgical reconstruction of the exstrophy-epispadias complex.J Pediatr Urol. 2008; 4: 460-466https://doi.org/10.1016/j.jpurol.2008.02.005
- Complications after primary bladder exstrophy closure - role of pelvic osteotomy.Cent European J Urol. 2013; 66: 104-108https://doi.org/10.5173/ceju.2013.01.art31
- Impact of pelvic immobilization techniques on the outcomes of primary and secondary closures of classic bladder exstrophy.J Pediatr Urol. 2019; 15: 382.e1-382.e8https://doi.org/10.1016/j.jpurol.2019.04.009
- Perioperative blood transfusions in orthopaedic surgery.J Bone Joint Surg Am. 2014; 96: 1836-1844https://doi.org/10.2106/JBJS.N.00128
- Blood transfusion is a critical determinant of resource utilization and total hospital cost in liver transplantation.Clin Transplant. 2018; 32https://doi.org/10.1111/ctr.13164
- Predictors and outcomes of perioperative blood transfusions in classic bladder exstrophy repair: a single institution study.J Pediatr Urol. 2018; 14: 430.e1-430.e6https://doi.org/10.1016/j.jpurol.2018.04.025
- The inadequate bladder template: its effect on outcomes in classic bladder exstrophy.J Pediatr Urol. 2018; 14: 427.e1-427.e7https://doi.org/10.1016/j.jpurol.2018.03.023
- Delaying primary closure of classic bladder exstrophy: when is it too late?.J Pediatr Urol. 2020; 16: 834.e1-834.e7https://doi.org/10.1016/j.jpurol.2020.09.003
- The newborn exstrophy bladder inadequate for primary closure: evaluation, management and outcome.J Urol. 2001; 165: 1656-1659
- Recent trends in the management of bladder exstrophy: the gordian knot has not yet been cut.Front Pediatr. 2019; 7: 110https://doi.org/10.3389/fped.2019.00110
- Determinants of continence in the bladder exstrophy population: predictors of success?.Urology. 2001; 57: 774-777https://doi.org/10.1016/s0090-4295(00)01102-x
Article info
Publication history
Published online: January 04, 2023
Accepted:
January 3,
2023
Received in revised form:
November 29,
2022
Received:
October 14,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
