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Secondary reclosure in classic bladder exstrophy: challenges and outcomes
Brian M Inouye1, Heather N Di Carlo1, Ezekiel E Young1
1Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.
Urology
|April 29, 2015
Summary
Failed classic bladder exstrophy (CBE) reclosures impact continence. Pelvic osteotomy with proper immobilization during reclosure improves bladder capacity for bladder neck reconstruction (BNR).
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Urology
Background:
- Classic bladder exstrophy (CBE) reclosure failures diminish the likelihood of achieving urinary continence.
- Pelvic osteotomy is often employed during reclosure to enhance outcomes, but reclosure can still fail.
- Understanding the impact of pelvic osteotomy on failed CBE reclosures is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the outcomes of failed classic bladder exstrophy (CBE) reclosures, comparing those performed with and without pelvic osteotomy.
- To identify factors influencing the success of reclosure in patients with a history of failed closures.
Main Methods:
- A review of an institutional database of 1210 exstrophy-epispadias complex patients identified 17 CBE patients who underwent a third closure after two prior failures.
- Data analyzed included patient demographics, closure history, diastasis distance, bladder capacity, and outcomes.
- Chi-square tests compared outcomes between patients who had pelvic osteotomy during reclosure versus those who did not.
Main Results:
- Of 17 patients, 12 had osteotomy (group 1) and 5 did not (group 2).
- No significant difference in achieving sufficient bladder capacity (100 cc) for bladder neck reconstruction (BNR) was observed between groups (42% vs 40%).
- However, within the osteotomy group, proper immobilization with external fixation significantly increased the rate of achieving sufficient bladder capacity (80% vs 14%).
Conclusions:
- Each successive failed classic bladder exstrophy (CBE) closure negatively impacts outcomes.
- Reclosure procedures for CBE should incorporate pelvic osteotomy and proper immobilization to maximize the chances of achieving adequate bladder capacity for subsequent procedures like bladder neck reconstruction or augmentation cystoplasty.
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