Bladder exstrophy: An overview of the surgical management

Area of Science:

• Pediatric Urology
• Reconstructive Surgery
• Genitourinary Reconstruction

Background:

• Urinary bladder exstrophy presents significant surgical challenges.
• This study details over 25 years of personal experience in managing bladder exstrophy at a tertiary care center.

Purpose of the Study:

• To evaluate the long-term outcomes of surgical interventions for bladder exstrophy.
• To assess methods for achieving socially acceptable urinary continence in affected patients.

Main Methods:

• Retrospective analysis of 210 classical bladder exstrophy cases treated between 1984 and 2010.
• Surgical reconstruction involved bladder closure, abdominal wall repair, ureteral reimplantation, epispadias repair, and augmentation cystoplasty.
• Clinical and urodynamic assessments were used for patient evaluation.

Main Results:

• 105 patients achieved socially acceptable continence.
• Continence was achieved in 57 patients following bladder neck reconstruction and 48 after augmentation cystoplasty.
• Further surgical options were offered to patients with inadequate continence.

Conclusions:

• Achieving socially acceptable continence in bladder exstrophy is possible with persistent surgical management.
• Bladder neck division and continent stomas serve as last-resort options.
• Urodynamic assessment and anticholinergic medications are vital for patient management.