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Updated: Aug 16, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Complete primary repair of bladder exstrophy in children presenting late and those with failed initial closure:
Ashraf T Hafez1, Mohamed T El-Sherbiny, Ahmed A Shorrab
1From the Departments of Urology, Orthopedics and Anesthesia, Faculty of Medicine, Mansoura University, Mansoura, Egypt. athafez@yahoo.com
Insights
Complete primary repair (CPR) of bladder exstrophy is feasible for late presentations. While 50% of girls achieved continence, most boys require further bladder neck reconstruction.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Bladder exstrophy requires complex surgical correction.
- Complete primary repair (CPR) using Mitchell's technique is a common approach.
- Late presentation or failed initial closure poses unique challenges.
Purpose of the Study:
- To evaluate the single-center experience with CPR for bladder exstrophy in children presenting late or after failed initial closure.
- To assess the outcomes of Mitchell's technique in this specific patient cohort.
Main Methods:
- Retrospective review of 30 children (22 boys, 8 girls) undergoing CPR with Mitchell's technique.
- Mean age at surgery was 3.2 years; 63% had prior failed closure.
- Bilateral anterior iliac osteotomies, pre- and post-operative ultrasounds, and serial voiding cystourethrography were performed.
Main Results:
- Mean follow-up was 40 months.
- Hypospadias occurred in 77% of boys.
- Continence was achieved in 50% of girls and 16% of boys without further surgery.
- 17% required intestinal bladder augmentation; 63% had transient hydronephrosis.
Conclusions:
- CPR is a feasible option for late-presenting bladder exstrophy.
- Significant rates of hypospadias in boys and need for bladder neck reconstruction are noted.
- Continence rates vary by sex, with girls achieving better outcomes without additional procedures.
Purpose:
Complete primary repair (CPR) of bladder exstrophy using Mitchell's technique gained wide popularity. We present a single center experience with CPR in 30 children with bladder exstrophy presenting late or after failed initial closure.
Materials And Methods:
Between November 1998 and November 2003, 45 patients underwent CPR of bladder exstrophy using Mitchell's technique. All 22 boys and 8 girls presenting beyond the age of 1 year were evaluated. Of the 30 patients 19 (63%) had a history of failed exstrophy closure. Mean patient age at surgery was 3.2 years (range 1 to 8). Bilateral anterior iliac osteotomies were performed in all children. Ultrasound was performed before surgery and 3 months thereafter in all patients. Voiding cystourethrography was obtained at 3 months and then annually. Continence was defined as dry intervals of 3 hours or more.
Results:
Mean followup is 40 months (range 5 to 64). Concomitant intestinal bladder augmentation was performed in 5 children (17%). The repair resulted in hypospadias in 17 of 22 boys (77%). Following catheter removal 7 patients (23%) had suprapubic urine leakage that ceased spontaneously in all. Early postoperative hydronephrosis was present in 19 of the 30 children (63%) and resolved spontaneously in all. Six patients (20%) had febrile urinary tract infection that was treated conservatively. Vesicoureteral reflux was present in 23 children (68%). Of the 5 patients treated with concomitant bladder augmentation 2 are continent, 2 underwent bladder neck closure and 1 underwent bladder neck reconstruction (BNR). All 5 patients are currently dry. The remaining 25 patients had a mean bladder capacity of 90 ml (range 30 to 200) with continence in 6 children (24%). Continence was achieved in 3 of 6 girls (50%) versus 3 of 19 boys (16%). Five patients underwent BNR with ileocystoplasty in 4. The remaining 14 patients are awaiting BNR with or without bladder augmentation.
Conclusions:
CPR of bladder exstrophy is feasible in children presenting late or after failed initial closure. Concomitant intestinal bladder augmentation was required in 17% of our patients. The procedure resulted in hypospadias in 77% of the boys. Continence was achievable in 50% of the girls without subsequent bladder neck surgery. On the other hand, most boys (84%) will require BNR with or without augmentation.