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Continence and classic bladder exstrophy treated with staged repair.
Matthew B K Shaw1, Richard C Rink, Martin Kaefer
1Department of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202, USA.
The Journal of Urology
|September 17, 2004
Summary
Urinary continence is achievable in most classic bladder exstrophy patients. Bladder augmentation significantly improves continence rates, though bladder neck reconstruction alone is less effective.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Classic bladder exstrophy presents challenges in achieving urinary continence.
- Staged reconstruction is a common approach for managing bladder exstrophy.
- Optimizing urinary continence remains a key goal in surgical management.
Purpose of the Study:
- To review surgical outcomes for urinary continence in classic bladder exstrophy.
- To identify procedures that optimize urinary continence.
- To evaluate the effectiveness of different reconstructive techniques.
Main Methods:
- Retrospective review of patients with classic bladder exstrophy (1976-2001).
- Analysis of staged reconstruction procedures and their association with continence.
- Defined criteria for continence, partial continence, and incontinence.
Main Results:
- 90% of patients achieved continence, 8% partial continence, and 2% remained incontinent.
- Bladder augmentation was required in 70% of continent patients.
- Bladder neck reconstruction alone resulted in continence in only 34% of cases, with many requiring subsequent augmentation.
Conclusions:
- Urinary continence is attainable in the majority of classic bladder exstrophy cases.
- Bladder augmentation is a critical procedure for achieving high continence rates.
- Bladder neck reconstruction alone has limited success in establishing long-term continence.