Coping with bladder exstrophy: diverse results from early attempts at functional urinary tract surgery

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Bladder exstrophy (BE) is a complex congenital anomaly requiring surgical intervention.
• Early surgical techniques for BE aimed at functional closure, leading to varied genitourinary tract outcomes in adulthood.
• Long-term outcomes of early BE treatments are crucial for understanding adult patient well-being.

Purpose of the Study:

• To evaluate the long-term surgical outcomes in patients with bladder exstrophy treated between 1960 and 1982.
• To assess the physical health, social integration, and sexual function of this cohort.
• To understand the impact of evolving surgical approaches on adult patients with bladder exstrophy.

Main Methods:

• Retrospective review of medical records for 36 patients treated for bladder exstrophy.
• Follow-up data collected from 15 evaluable subjects (7 men, 8 women) via interviews and the SF-36 v2 Health Survey.
• Assessment of genitourinary status, renal function, sexual function, and psychosocial well-being.

Main Results:

• 11 patients required urinary diversion after initial bladder closure; 3 retained bladder function.
• 25 of 27 functioning renal units were in reasonable to good condition.
• Acceptable sexual function reported, with most patients achieving social integration, education, and employment.
• Mean SF-36 scores indicated generally good health and well-being, with variations between genders.

Conclusions:

• Long-term follow-up reveals that bladder exstrophy surgery, despite historical variations, leads to good renal preservation and functional outcomes.
• Adults treated for bladder exstrophy exhibit robust physical health, social adjustment, and acceptable sexual function.
• Multidisciplinary adolescent follow-up is essential for a successful transition to adulthood for individuals with bladder exstrophy.