Modern staged repair of bladder exstrophy: A contemporary series

A. D. Baird, C. P. Nelson, John Phillip Gearhart

Research output: Contribution to journalArticle

Abstract

Objective: Many changes have occurred in the treatment of bladder exstrophy over the last few years and many repairs are now offered. The purpose of this study was to evaluate long-term outcomes in a select group of patients in whom modern staged repair (MSRE) was undertaken. Patients and methods: From an institutionally approved database were extracted 189 patients who had undergone primary closure between 1988 and 2004. The records of 131 patients (95 males) who underwent MSRE with a modified Cantwell-Ransley repair by a single surgeon in 1988-2004 were reviewed with a minimum 5-year follow up. Results: Sixty-seven patients with a mean age of 2 months (range 6 h to 4 months) underwent primary closure, and 18 underwent osteotomy at the same time. Mean age at epispadias repair was 18 months (8-24). Mean age at bladder neck reconstruction (BNR) was 4.8 years (40-60 months) with a mean capacity of 98 cc (75-185). Analysis of bladder capacity prior to BNR revealed that patients with a mean capacity greater than 85 cc median had better outcomes. Seventy percent (n = 47) are continent day and night and voiding per urethra without augmentation or intermittent catheterization. Social continence defined as dry for more than 3 h during the day was found in 10% (n = 7). Six patients required continent diversion after failed BNR. Seven patients are completely incontinent. The mean time to daytime continence was 14 months (4-23) and the mean time to night-time continence was 23 months (11-34). No correlation was found between age at BNR and continence. Conclusions: Patients with a good bladder template who develop sufficient bladder capacity after successful primary closure and epispadias repair can achieve acceptable continence without bladder augmentation and intermittent catheterization.

Original languageEnglish (US)
Pages (from-to)311-315
Number of pages5
JournalJournal of Pediatric Urology
Volume3
Issue number4
DOIs
StatePublished - Aug 2007

Fingerprint

Bladder Exstrophy
Urinary Bladder
Epispadias
Catheterization
Urethra
Osteotomy
Databases

Keywords

  • Bladder exstrophy
  • Reconstruction
  • Staged repair

ASJC Scopus subject areas

  • Urology
  • Pediatrics, Perinatology, and Child Health

Cite this

Modern staged repair of bladder exstrophy : A contemporary series. / Baird, A. D.; Nelson, C. P.; Gearhart, John Phillip.

In: Journal of Pediatric Urology, Vol. 3, No. 4, 08.2007, p. 311-315.

Research output: Contribution to journalArticle

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