Bladder function and dysfunction in exstrophy and epispadias

Area of Science:

• Pediatric Urology
• Congenital Abnormalities
• Lower Urinary Tract Function

Background:

• Bladder exstrophy and epispadias are congenital urinary tract abnormalities.
• Previous bladder function evaluation before and after reconstruction is limited.
• Optimal treatment strategies require better understanding of bladder function.

Purpose of the Study:

• To prospectively evaluate lower urinary tract function in children with bladder exstrophy and epispadias.
• To assess bladder function before and after bladder-neck reconstruction.
• To identify factors contributing to persistent urinary leakage and upper urinary tract damage.

Main Methods:

• Prospective study of 36 children (1.5–16 years) with bladder exstrophy and epispadias.
• Lower urinary tract function assessed by cystometry and cystography.
• Upper urinary tract evaluation using ultrasound imaging.

Main Results:

• Normal bladder function observed in primary epispadias cases.
• Conventional bladder-neck surgery for continence severely impaired bladder function.
• Involuntary bladder contractions identified as a cause of persistent urine leakage.
• Abnormalities may hinder bladder capacity development and cause upper urinary tract damage.

Conclusions:

• Conventional bladder-neck surgery may not be the optimal treatment for bladder exstrophy and epispadias.
• Closed exstrophy bladders do not achieve normal function.
• Involuntary bladder contractions are a significant issue post-surgery.
• Routine detailed functional testing is recommended for these patients.