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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Delayed primary repair of bladder exstrophy: ultimate effect on growth
Nima Baradaran1, Raimondo M Cervellione, Andrew A Stec
1Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
The Journal of Urology
|October 24, 2012
Summary
Delayed bladder exstrophy repair does not affect bladder growth rate. However, smaller initial bladder templates result in smaller capacities and fewer successful bladder neck reconstructions.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Delayed primary repair of bladder exstrophy is sometimes necessary due to late referrals or small bladder templates.
- Understanding the impact of delayed repair on bladder growth and eventual capacity is crucial for surgical planning and patient outcomes.
Purpose of the Study:
- To investigate longitudinal bladder growth rates in patients with classic bladder exstrophy undergoing delayed primary closure.
- To compare eventual bladder capacities and outcomes between neonatally and delayed repaired exstrophy cases.
Main Methods:
- Retrospective review of medical records for patients with classic bladder exstrophy (1970-2006).
- Comparison of clinical characteristics and annual cystographic bladder capacity before continence procedures.
- Exclusion of failed primary exstrophy repairs.
Main Results:
- Delayed closure (due to small template or late referral) did not significantly alter the rate of bladder growth compared to neonatal closure.
- Bladder capacities were smaller in delayed repair groups (36 ml smaller for small templates, 29 ml smaller for late referrals).
- Pelvic osteotomy was common in delayed closures (32/33 patients).
Conclusions:
- Delayed primary repair of bladder exstrophy does not compromise the rate of bladder growth.
- Children with smaller initial bladder templates have smaller overall bladder capacities.
- Smaller bladder capacities in delayed repair cases are associated with a lower likelihood of successful bladder neck reconstruction.
