Can Classic Bladder Exstrophy be Safely and Successfully Reconstructed at a Low Volume Center?

Jacob Ben-Chaim, Yosef Binyamini, Eitan Segev, Mario Sofer, Yuval Bar-Yosef

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose Exstrophy reconstruction is challenging and requires expertise and experience. However, many patients are treated at low volume centers. We evaluated whether classic bladder exstrophy could be safely and successfully reconstructed at a low volume center. Materials and Methods A total of 31 patients with classic bladder exstrophy were primarily treated at our low volume center during a 17-year period. A total of 22 patients underwent primary closure within 5 days of birth and 9 underwent delayed closure with osteotomy. Of the patients 29 underwent planned modern staged repair and 2 underwent attempted complete primary repair. Results The bladder was successfully closed in all 31 children. All 22 newborns underwent primary bladder closure without osteotomy, including 4 with extremely small bladder plates. Bladder neck obstruction developed in 3 patients (10%), of whom 2 were treated successfully with transurethral dilation and 1 underwent open repair. Epispadias repair was successful in 12 of 15 patients undergoing the Cantwell-Ransley technique and in 2 of 4 undergoing complete primary repair. A total of 16 patients underwent bladder neck reconstruction, of whom 9 are awaiting appropriate age or capacity, 4 were lost to followup, 1 is continent after bladder closure alone and 2 underwent continent diversion (1 after failed bladder neck reconstruction). Of the 15 patients with at least 1 year of followup after bladder neck reconstruction 9 are continent day and night, 2 are continent only during the daytime and 4 are incontinent, for a 73% post-bladder neck reconstruction continence rate (11 of 15 patients). Conclusions Successful exstrophy reconstruction is achievable at a low volume center, with results comparable to those of high volume centers.

Original languageEnglish
Pages (from-to)150-154
Number of pages5
JournalJournal of Urology
Volume195
Issue number1
DOIs
StatePublished - 1 Jan 2016

Keywords

  • bladder exstrophy
  • epispadias
  • urinary incontinence
  • urologic surgical procedures

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