Long-term functional outcomes after bladder exstrophy repair: A single, low-volume centre experience

Area of Science:

• Pediatric Urology
• Surgical Management
• Congenital Anomalies

Background:

• Bladder exstrophy (BE) is a complex congenital anomaly requiring specialized surgical management.
• Managing BE in low-volume centers presents unique challenges.
• This study reviews 24 years of BE management experience.

Purpose of the Study:

• To evaluate the outcomes of bladder exstrophy (BE) management in a low-volume center.
• To assess the effectiveness of different surgical techniques and secondary procedures for achieving urinary continence.
• To provide insights for optimizing BE care strategies.

Main Methods:

• Retrospective review of 16 patients with BE treated between 1990 and 2014 with at least 5 years follow-up.
• BE closure performed within the first two days of life using complete primary repair (CPRE) or modern-staged repair (MSRE).
• Evaluation of daytime urinary continence (UC) by age five, with subsequent bladder neck reconstruction (BNR) and/or augmentation cystoplasty (ACP) for persistent incontinence.

Main Results:

• A total of 16 patients were included, with a mean follow-up of 18 years.
• Continence was achieved in 15 out of 16 patients (93.8%) after secondary procedures.
• Complications included dehiscence, vesicocutaneous fistula, and urinary tract infections (UTIs).
• Urethral voiding was achieved in 60% of patients.

Conclusions:

• High continence rates are achievable in BE management, even in low-volume settings, with the addition of secondary procedures.
• The expertise of the surgical team significantly influences outcomes, suggesting a benefit from centralized care.
• Further research is needed to compare CPRE and MSRE outcomes and to establish optimal management protocols for BE.