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Alternative management of bladder exstrophy.

Rita Gobet1

  • 1Division of Pediatric Urology, University Children's Hospital, Zürich, Switzerland. Rita.Gobet@kispi.uzh.ch

Current Opinion in Urology
|May 23, 2009
PubMed
Summary
This summary is machine-generated.

Long-term outcomes show primary urinary diversions like ureterosigmoidostomy (USS) offer high continence. Complete primary repair of bladder exstrophy (CPRE) often requires multiple procedures and may not achieve normal voiding.

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Area of Science:

  • Pediatric Urology
  • Surgical Management
  • Bladder Exstrophy Treatment

Background:

  • Bladder exstrophy management requires reassessment due to long-term outcome studies.
  • Traditional and reconstructive approaches have varying long-term results.

Purpose of the Study:

  • To review and compare long-term outcomes of different bladder exstrophy treatments.
  • To evaluate the efficacy of primary urinary diversions versus primary reconstruction.

Main Methods:

  • Review of long-time outcome studies for bladder exstrophy patients.
  • Analysis of continence rates and need for secondary procedures.

Main Results:

  • High long-term continence rates (mean 50 years) observed with ureterosigmoidostomy (USS) and Mainz II pouch.
  • Complete primary repair of bladder exstrophy (CPRE) frequently necessitates multiple procedures for continence and functional genitalia.
  • Multiple staged repair of bladder exstrophy (MSRE) often requires augmentation and may not achieve normal voiding.
  • Concerns exist regarding tumor formation risk with intestinal tissue inclusion in the urinary tract.

Conclusions:

  • The goal of normal voiding via single-stage CPRE may be unmet.
  • Long-term concerns with reconstructive techniques include tumor risk and durability of bladder neck repair (BNR).
  • Psychosocial, sexual outcomes, and fertility require consideration in long-term bladder exstrophy management.