Long-term results of surgical treatment of bladder exstrophy

A review of the long-term results of the treatment of 18 cases of bladder exstrophy is reported. Five cases have been operated on before 1961 by ureterosigmoidostomy; 4 (80%) patients have good renal function and have not had any complications, although 1 patient has anal incontinence; 1 patient presented bilateral renoureteral complications, requiring several corrective operations, and has anal incontinence too. Out of 13 cases operated on after 1961, 10 have been followed up from 3 to 14 years. In 1 patient an ileal conduit was performed because of the failure of an ureterosigmoidostomy performed at another hospital 10 years before. In 9 patients a personal technique based on the bladder substitution by a colonic loop plus creation of a sphincteric mechanism by trigonal tubulization was used (enterotrigonal urethroplasty). Morbidity has been high (66.6%), but the end results are very satisfactory: 7 patients (77.7%) are currently living a normal life, with normal renal function and good continence; 1 patient is incontinent and has bilateral reflux and a left retracted kidney; 1 patient has been secondarily diverted by means of a cutaneous Y transuretero-ureterostomy due to gross lreteral dilatation, renal damage and incontinence.