Continent Anal Urinary Diversion in Classic Bladder Exstrophy: 45-Year Experience

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Urology

Background:

• Bladder exstrophy is a complex congenital anomaly requiring reconstructive surgery.
• Continent anal urinary diversion (CAD) is a salvage procedure for patients with failed lower urinary tract reconstruction.
• Long-term outcomes of CAD in bladder exstrophy are not well-established.

Purpose of the Study:

• To evaluate the long-term outcomes of continent anal urinary diversion (CAD) in patients with classic bladder exstrophy.
• Assess continence, upper urinary tract status, secondary malignancies, and sexual function after CAD.

Main Methods:

• Retrospective review of medical records for 82 bladder exstrophy patients who underwent CAD (1970-2015).
• Follow-up examinations and validated questionnaires (FSFI, IIEF) were used to assess outcomes.
• Median follow-up duration was 23.9 years.

Main Results:

• High rates of daytime continence (97%) were observed.
• Upper urinary tract and renal function remained stable in a majority of patients (75% and 87%).
• Secondary malignancies developed in 5 patients; sexual function was negatively impacted in both genders, though relationships and fertility were maintained in a significant proportion.

Conclusions:

• CAD is an effective treatment for bladder exstrophy when lower urinary tract reconstruction fails, offering acceptable long-term outcomes.
• Long-term surveillance including upper urinary tract monitoring, acid-base balance assessment, and rectal reservoir endoscopy is essential.
• Active evaluation and management of sexual dysfunction should be integrated into patient follow-up.