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Related Experiment Video

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Urinary Bladder Distention Evoked Visceromotor Responses as a Model for Bladder Pain in Mice
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The inadequate bladder template: Its effect on outcomes in classic bladder exstrophy.

Heather N Di Carlo1, Mahir Maruf1, John Jayman1

  • 1Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.

Journal of Pediatric Urology
|June 18, 2018
PubMed
Summary

Delayed primary closure (DPC) for classic bladder exstrophy (CBE) with inadequate bladder templates yields successful outcomes. While continence may be achieved later, DPC supports bladder growth and positive surgical results in these patients.

Keywords:
Bladder capacityBladder exstrophyBladder templateDelayed closureUrinary continence

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Area of Science:

  • Pediatric Urology
  • Surgical Innovation
  • Congenital Abnormalities

Background:

  • Classic bladder exstrophy (CBE) can present with inadequate bladder templates for neonatal closure.
  • Delayed primary closure (DPC) allows for bladder growth before surgical repair.
  • Comparing outcomes of DPC in poor-template CBE versus other indications is crucial for surgical planning.

Purpose of the Study:

  • To evaluate surgical and long-term urinary continence outcomes in CBE patients with poor bladder templates undergoing DPC.
  • To compare these outcomes with CBE patients undergoing DPC for reasons other than bladder quality.

Main Methods:

  • Retrospective review of a prospectively maintained database of 1330 exstrophy-epispadias complex patients.
  • Identification of 63 CBE patients who underwent DPC, categorized into two groups: inadequate bladder templates (n=36) and adequate templates with delayed closure for other reasons (n=27).
  • Analysis of surgical success, bladder capacity, continence procedures, and age at continence.

Main Results:

  • All patients achieved successful primary closure.
  • Bladder capacities and the number of continence procedures were similar between groups.
  • Patients with inadequate templates experienced a later age of first continence procedure and achieved continence later.
  • A higher proportion of inadequate template patients required urinary diversion for continence.

Conclusions:

  • Delayed primary closure (DPC) is a successful strategy for classic bladder exstrophy (CBE) patients with inadequate bladder templates.
  • While continence may be achieved at a later age, DPC does not negatively impact overall continence outcomes or bladder growth.
  • Inadequate bladder templates influence the type of continence procedure and necessitate longer surveillance for optimal management.