Delayed primary closure of bladder exstrophy: immediate postoperative management leading to successful outcomes
Nima Baradaran1, Andrew A Stec, Anthony J Schaeffer
1Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
Insights
Delayed primary bladder closure for bladder exstrophy is highly successful with a comprehensive postoperative plan. This includes osteotomy, pelvic immobilization, effective pain management, nutritional support, and infection prevention.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Bladder exstrophy repair requires meticulous postoperative management for successful outcomes.
- Delayed primary closure is an alternative surgical approach for certain bladder exstrophy cases.
Purpose of the Study:
- To outline the critical features of a postoperative plan for children undergoing delayed primary bladder closure.
- To emphasize the importance of appropriate postoperative management in exstrophy repair.
Main Methods:
- Retrospective review of patients with bladder exstrophy undergoing delayed primary closure (at least 1 month after birth).
- Analysis of all aspects of postoperative management, including surgical techniques, pain control, and supportive care.
Main Results:
- 20 patients (19 classic bladder exstrophy) underwent delayed closure at a mean age of 9.9 months.
- Successful outcomes (100%) were achieved with pelvic osteotomy, prolonged epidural analgesia, ureteral catheters, suprapubic tubes, nutritional support, and antibiotics.
- Mean hospital stay was 6.3 weeks with an average follow-up of 7.4 years.
Conclusions:
- Delayed primary closure of bladder exstrophy can be 100% successful.
- Key elements for success include a multidisciplinary approach, osteotomy, pelvic immobilization, analgesia, nutritional support, maximal bladder drainage, and infection prophylaxis.
Objective:
To present the critical features of our postoperative plan for children undergoing delayed primary bladder closure because appropriate postoperative management is crucial to successful exstrophy repair.
Methods:
Using an institutionally approved database, patients with bladder exstrophy whose primary bladder closure was performed at least 1 month after birth were identified. All aspects of the postoperative management were reviewed.
Results:
A total of 20 patients (18 boys) were identified: 19 with classic bladder extrosphy and 1 with an exstrophy variant. The patients underwent closure at a mean age of 9.9 months. All patients underwent pelvic osteotomy and immobilization for an average of 34.8 days. Analgesia was administered by way of a tunneled epidural catheter in 90% of patients for an average of 18.8 days, and 12 patients (60%) required adjunct intravenous analgesia. Bilateral ureteral catheters and suprapubic tubes were used in all patients. Total parenteral nutrition was administered to 10 (83%) of 12 patients who underwent closure after 2000. All patients received preoperative antibiotics and 2 weeks of postoperative intravenous antibiotics that was followed by oral prophylaxis. The mean hospital stay was 6.3 weeks. With an average follow-up of 7.4 years, delayed closure was 100% successful.
Conclusion:
Successful delayed primary closure of bladder exstrophy requires a multidisciplinary approach. The keys to success include osteotomy, pelvic immobilization, analgesia, nutritional support, maximal bladder drainage, and infection prophylaxis.
