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J Pediatr Urol. 2007 Aug;3(4):311-5. doi: 10.1016/j.jpurol.2006.09.009. Epub 2006 Dec 26.

Modern staged repair of bladder exstrophy: a contemporary series.

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  • 1Division of Pediatric Urology, Brady Urological Institute, Marburg 146, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA. andy.baird@ntlworld.com

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 3h 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.

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