Augmentation cystoplasty in patients with exstrophy-epispadias

In a series of over 200 patients with exstrophy-epispadias from the Mayo Clinic, a subgroup of 11 with small bladder capacities, decreased detrusor compliance, and urinary incontinence underwent augmentation cystoplasty. Preaugmentation bladder capacities were between 25 and 250 mL (mean, 73 mL). Bladder capacities after enterocystoplasty improved significantly, with a range between 180 and 500 mL (mean, 355 mL). Ten of the 11 patients have total urinary continence for greater than 3 hours. One child remains dry between 1 1/2 and 2 hours. Nine patients are in complete urinary retention and are managed by clean intermittent catheterization. Two patients void spontaneously by pelvic muscle relaxation and abdominal straining alone. All patients maintain normal or stable renal function postoperatively. Excretory urography showed decreased caliectasis in two patients with preoperative hydronephrosis and stable upper urinary tracts in nine patients. Enterocystoplasty can produce total urinary continence, preserve renal function, and avoid the long-term sequelae of urinary diversion in selected children born with exstrophy-epispadias.