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Related Experiment Videos

Management of the failed exstrophy closure.

J P Gearhart1, R D Jeffs

  • 1Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.

The Journal of Urology
|August 1, 1991
PubMed
Summary

Failed bladder exstrophy closure can be successfully managed with precise surgical techniques, including osteotomy and, for males, epispadias repair. This approach ensures secure reclosure and improved outcomes for complex cases.

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Area of Science:

  • Pediatric Surgery
  • Urology
  • Congenital Abnormalities

Background:

  • Bladder exstrophy is a complex congenital anomaly requiring surgical closure.
  • Failed exstrophy closure presents significant challenges in pediatric urology.
  • Secondary closure often involves complex reconstructive procedures.

Purpose of the Study:

  • To evaluate the outcomes of secondary bladder exstrophy closure in patients with failed initial repairs.
  • To identify key surgical factors contributing to successful reclosure.
  • To assess the efficacy of osteotomy and epispadias repair in managing failed exstrophy closure.

Main Methods:

  • Retrospective review of 24 patients with failed bladder exstrophy closure.
  • Analysis of surgical techniques including posterior iliac or anterior innominate osteotomy.

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  • Evaluation of concomitant epispadias repair and subsequent bladder neck reconstruction or augmentation cystoplasty.

    • Main Results:

    • All referred patients underwent either posterior iliac or anterior innominate osteotomy.
    • No instances of reclosure failure were observed in the study group.
    • Seven of eight patients undergoing bladder neck reconstruction achieved 4-hour continence; two underwent successful augmentation cystoplasty.

    Conclusions:

    • Secure reclosure of failed bladder exstrophy is achievable with meticulous surgical technique.
    • Osteotomy, regardless of prior procedures, is crucial for successful secondary closure.
    • Concomitant epispadias repair in male subjects improves overall functional outcomes.