The modern staged repair of classic bladder exstrophy: A detailed postoperative management strategy for primary bladder closure

Andrew A. Stec, Nima Baradaran, Anthony Schaeffer, John P. Gearhart, Ranjiv I. Matthews

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed. Materials and methods: Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway. Results: Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%. Conclusions: A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy.

Original languageEnglish (US)
Pages (from-to)549-555
Number of pages7
JournalJournal of pediatric urology
Volume8
Issue number5
DOIs
StatePublished - Oct 2012

Keywords

  • Bladder
  • Exstrophy
  • Primary closure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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