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Complete primary repair of bladder exstrophy: initial experience with 33 cases
Hisham M Hammouda1, Hassan Kotb
1Urology (Pediatric Urology Division) Department, Assiut University, Assiut, Egypt.
Insights
Complete primary repair of bladder exstrophy in children, using penile disassembly and osteotomy, shows promising results for continence and renal function. This approach can avoid bladder neck reconstruction in select cases.
Area of Science:
- Pediatric Surgery
- Urology
- Congenital Anomalies
Background:
- Bladder exstrophy is a complex congenital anomaly requiring surgical correction.
- Complete primary repair aims to achieve anatomical and functional reconstruction in a single stage.
Purpose of the Study:
- To evaluate the initial experience with complete primary repair of bladder exstrophy in 33 children.
- To assess the efficacy and outcomes of a one-stage repair technique.
Main Methods:
- A series of 33 children with classic bladder exstrophy underwent one-stage primary repair.
- Techniques included bladder closure in continuity with the urethra, penile disassembly for epispadias repair, and anterior transverse innominate osteotomy.
- Combined anesthesia with epidural caudal catheterization was used in some cases.
Main Results:
- Median follow-up was 42 months.
- 72.7% of children achieved a dry interval of 3 hours or greater.
- Complications included bladder neck fistula (2) and urethral fistula (1); no renal function loss or febrile UTIs were recorded.
- Vesicoureteral reflux was noted in 6 patients, and 3 required enterocystoplasty for small bladder plates.
Conclusions:
- Complete primary repair with penile disassembly is a viable approach for bladder exstrophy.
- This technique can potentially obviate the need for bladder neck reconstruction in some patients.
- Optimizing surgical technique, adjunctive procedures like osteotomy, and pain management are crucial for successful outcomes.
Purpose:
We evaluated our initial experience with complete primary repair of bladder exstrophy in 33 children.
Materials And Methods:
Between 1998 and 2001, 33 children with classic bladder exstrophy were treated with 1-stage primary repair for the first time in all except 4, who had undergone previous failed initial bladder closure. Our series included 26 boys and 7 girls with a mean age of 2 months (range 3 weeks to 14 months). The bladder was closed in continuity with the urethra and complete penile disassembly was used for epispadias repair. Anterior transverse innominate osteotomy was performed in all cases. Combined general and caudal anaesthesia were applied in all cases with an indwelling epidural caudal catheter in 7.
Results:
Median followup was 42 months (range 24 to 62). Enterocystoplasty was needed in 3 cases during primary repair of a small bladder plate. Wound dehiscence was not recorded. Bladder neck fistula was reported in 2 children, while urethral fistula was recorded in 1 boy. Abdominal ultrasound detected no hydronephrosis in all except 3 patients. Voiding cystourethrogram showed vesicoureteral reflux in 6 patients. No loss of renal function or febrile urinary tract infection was recorded. A dry interval of 3 hours or greater was reported in 24 children (72.7%), while 9 who were incontinent of urine after failed toilet training needed other procedures to achieve continence.
Conclusions:
Complete primary repair with penile disassembly provides a good approach to achieve this purpose without the need for bladder neck reconstruction in some cases. Selection of the proper surgical technique together with adjunctive procedures such as osteotomy and a pain-free early postoperative period can maximize the chance of successful exstrophy repair.