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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.
The Journal of Urology
|September 17, 2004
Summary
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.