[Development of treatment for extrophy-epispadias in Germany]

While repair of exstrophy has a long tradition in Germany, a comprehensive review of the medical history of exstrophy-epispadias repair and its frequent inconsistencies and setbacks in Germany has not previously been published. Numerous resources were used to collect the information described in this review. Older textbooks from the library of German Society of Urology (DGU) in Düsseldorf and from the School of Medicine Library at the Friedrich-Alexander University in Erlangen were used to collect information on the important steps in the treatment of bladder exstrophy and epispadias from the first report of it onward. A Medline search was done to collect appropriate information from after 1969. Schenck von Grafenberg was the first to describe exstrophy of the bladder, in his report published in 1597, while the term 'exstrophy' was first used by Chaussier in 1780. Isolated epispadias remained unknown and untreated until it was described by Morgagni in 1761. The initial attempts to treat this anomaly were restricted to controlling the incontinence. In 1869 Karl Thiersch described the etiology and anatomy of epispadias and reported on a case of epispadias reconstruction with a long-term follow-up of 11 years. As long ago as in 1897, Mickulicz enlarged a small exstrophic bladder by adding an ilial segment to make it possible to close the bladder. After the first really successful reconstruction of bladder exstrophy in 1942 by Young in the USA, various multiple-stage and single-stage reconstruction approaches emerged in Germany. From the start, urinary diversion was seen as an alternative to reconstruction in the treatment of bladder exstrophy. The first ureterosigmoidostomy was done in an exstrophy patient by Simon in Heidelberg in 1852, after which Maydl described a new technique based on transtrigonal sigmoidostomy for urinary diversion in 1894. There are now three approaches in current use in Germany for the management of bladder exstrophy-epispadias: reconstruction in various staged approaches, complete reconstruction in a single session, and the primary rectal reservoir (Mainz pouch II).