Complications of Primary Closure of Classic Bladder Exstrophy

Anthony J. Schaeffer, J. Todd Purves, Jeremy A. King, Paul D. Sponseller, Robert D. Jeffs, John P. Gearhart

Research output: Contribution to journalArticle

Abstract

Purpose: We report the urological, orthopedic and neurological complications of primary closure of classic bladder exstrophy using modern staged repair of exstrophy. Materials and Methods: An approved database identified 137 males and 57 females with classic bladder exstrophy who underwent primary repair by 1 of 2 surgeons in 23 years. A total of 185 patients underwent primary closure using modern staged repair of exstrophy with or without osteotomies, whereas 9 underwent delayed primary closure with epispadias repair at age 12 months. Of the patients 63 received osteotomies. Mean age at closure was 60 days and mean followup was 9 years. Results: There were 14 major complications (11%) and 27 minor complications (14%). Major urological complications included bladder prolapse or dehiscence in 6 male patients (3%), which was successfully reclosed. Major orthopedic complications, including osteotomy nonunion in 2 cases, leg length inequality in 1 and persistent joint pain in 1, developed in 4 of the 63 patients (6%) who underwent osteotomy. Major neurological complications included femoral nerve palsy in 4 patients (2%). There were 21 minor urological complications (11%), including posterior bladder outlet obstruction in 4 cases, urethrocutaneous fistula in 2, suprapubic tube removal in 2, intrapubic stitch erosion in 4, febrile urinary tract infection in 6 and surgical site infection in 3. Six patients (3%) had minor orthopedic complications, including pelvic osteomyelitis in 1, pin site infection in 3 and a pressure sore from immobilization in 1. Conclusions: Closure of bladder exstrophy is a safe surgery with an acceptable risk of complications. A critical review of outcomes provides insight to further refine the technique and manage complications when they develop.

Original languageEnglish (US)
Pages (from-to)1671-1674
Number of pages4
JournalJournal of Urology
Volume180
Issue number4 SUPPL.
DOIs
StatePublished - Oct 2008

Keywords

  • abnormalities
  • bladder
  • bladder exstrophy
  • complications
  • reconstructive surgical procedure

ASJC Scopus subject areas

  • Urology

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