Bladder exstrophy: increase in capacity following epispadias repair

Area of Science:

• Pediatric Urology
• Reconstructive Surgery
• Congenital Anomalies

Background:

• Classical bladder exstrophy poses challenges in achieving urinary continence, especially in patients with small bladder capacity post-initial closure.
• Small bladder capacity (<60 cc) in pediatric patients with bladder exstrophy complicates satisfactory bladder neck reconstruction.

Purpose of the Study:

• To review a 12-year institutional experience managing bladder exstrophy, focusing on patients with small bladder capacity.
• To evaluate the efficacy of staged reconstruction, including epispadias repair followed by bladder neck reconstruction, in improving continence in these patients.

Main Methods:

• Retrospective review of 155 children treated for bladder exstrophy.
• Analysis of 28 boys with initially small bladder capacity (<60 cc) undergoing staged reconstruction.
• Evaluation of bladder capacity changes, hydronephrosis, and continence rates post-epispadias repair and bladder neck reconstruction.

Main Results:

• Following staged reconstruction, bladder capacity increased by a median of 54.5 cc after 22 months.
• No cases of hydronephrosis were observed post-epispadias repair or bladder neck reconstruction.
• Of 25 patients undergoing bladder neck reconstruction, 88% achieved continence (dry interval >3 hours); 2 additional patients achieved continence with bladder augmentation.

Conclusions:

• Satisfactory urinary continence is achievable in bladder exstrophy patients with small bladder capacity.
• Epispadias repair preceding bladder neck reconstruction is a crucial step for successful management.
• Staged reconstruction offers a viable strategy for improving bladder capacity and achieving long-term continence.