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Bladder growth and development after complete primary repair of bladder exstrophy in the newborn with comparison to
Joseph G Borer1, Patricio C Gargollo, Daniel D Kinnamon
1Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA. joseph.borer@childrens.harvard.edu
Insights
Complete primary repair of bladder exstrophy (CPRE) shows improved bladder capacity growth and compliance compared to staged repair. CPRE also demonstrated universal bladder stability with no detrusor overactivity.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Bladder Dynamics
Background:
- Bladder exstrophy is a complex congenital anomaly requiring surgical correction.
- Traditional staged repair has known limitations in bladder growth and function.
- Complete primary repair of bladder exstrophy (CPRE) offers a single-stage approach.
Purpose of the Study:
- To compare bladder growth and functional dynamics after complete primary repair of bladder exstrophy (CPRE) versus the traditional staged repair approach.
- To evaluate long-term bladder capacity, compliance, and detrusor activity in patients undergoing different surgical methods for bladder exstrophy.
Main Methods:
- Retrospective review of patients who underwent CPRE (1996-2004) and staged repair (1979-1996).
- Utilized voiding cystourethrogram, radionuclide cystogram, and urodynamic studies for assessment.
- Estimated bladder capacity growth curves and compared percent predicted bladder capacity (PPBC), compliance, and detrusor overactivity.
Main Results:
- CPRE group showed significantly faster bladder capacity growth (28.9%/year) compared to the staged group (15.0%/year).
- CPRE group exhibited greater bladder compliance (124.4%) and universal bladder stability with no detrusor overactivity.
- Percent predicted bladder capacity (PPBC) was comparable between groups initially but showed different growth trajectories.
Conclusions:
- CPRE leads to superior bladder growth and improved functional dynamics, including enhanced compliance and stability.
- The CPRE technique appears to avoid pelvic floor neuromuscular compromise.
- While early PPBC may be similar, CPRE demonstrates better long-term bladder development potential.
Purpose:
We assessed bladder growth and dynamics following complete primary repair of bladder exstrophy (CPRE) compared to the staged approach.
Materials And Methods:
We reviewed the records of 16 boys and 7 girls who underwent CPRE within 3 days of life from 1996 to 2004 and compared them to the records of 8 boys and 6 girls treated with a staged repair from 1979 to 1996. Screening methods included voiding cystourethrogram, radionuclide cystogram and urodynamic study. We estimated growth curves for bladder capacity following repair in each group, and compared percent predicted bladder capacity (PPBC), compliance and detrusor overactivity between the CPRE and staged repair groups following bladder neck reconstruction.
Results:
Bladder capacity in the staged repair group was 69.8 ml (95% CI 46.7-104.4) immediately after bladder neck reconstruction and increased by 15.0% per year thereafter (95% CI 6.2-24.5, p = 0.002). In the CPRE group bladder capacity was 29.0 ml (95% CI 21.3-39.5) initially and increased by 28.9% per year thereafter (95% CI 17.4-41.5, p <0.001). PPBC started at 45.6% (95% CI 35.7-55.5) and increased 1.2% per year (95% CI -1.1-3.5, p = 0.29) following repair for all genders and surgery groups. Compliance was 124.4% (95% CI 22.6-310.7, p = 0.01) greater in the CPRE group at all times following repair. Detrusor overactivity was present in 0 of 19 patients in the CPRE group and 6 of 13 (46%) in the staged group (exact p = 0.002).
Conclusions:
Within the CPRE group bladder stability was universal, and sphincter electromyography was normal suggesting no neuromuscular compromise of the pelvic floor. At early followup, our results suggest that PPBC is equivalent irrespective of gender or management. Further objective evaluation is needed in both groups.
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