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Challenges in salvaging urinary continence following failed bladder exstrophy repair in a developing country
Moneer K Hanna1, Ibrahim Bassiouny2
1New York Weill-Cornell Hospital, New York, USA.
Journal of Pediatric Urology
|March 7, 2017
Summary
Management of urinary incontinence after failed bladder exstrophy repair can be complex. This study shows that various surgical strategies, including bladder augmentation and internal urinary diversion, can successfully restore continence in most patients.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Bladder Exstrophy Management
Background:
- Urinary incontinence following bladder exstrophy repair presents management challenges.
- Surgical options include urinary diversion or reconstructive surgery, with no universally defined approach.
Purpose of the Study:
- To review outcomes of different management strategies for urinary incontinence in patients with failed bladder exstrophy repairs.
- To analyze factors influencing surgical decisions in resource-limited settings.
Main Methods:
- Retrospective review of 61 incontinent patients (age 3-18) with failed bladder exstrophy repairs.
- Treatment groups included re-closure with osteotomy, Mainz II diversion, and bladder augmentation/reconstruction.
- Data collected on surgical outcomes and influencing factors.
Main Results:
- Mainz II diversion (16 patients) resulted in 100% continence for urine and stool.
- Bladder augmentation/reconstruction (34 patients) achieved 91% continence, with 44% requiring additional surgery.
- Malignant changes were noted in 2/26 cystectomy specimens.
Conclusions:
- Failed bladder exstrophy repairs can be salvaged to achieve continence in the majority of patients.
- The Mainz II internal diversion is a viable option for selected patients, particularly females with multiple surgical failures.
- Pre-operative bladder biopsy, parental counseling, and socio-economic factors are crucial in decision-making.
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