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Urinary Continence Outcomes in Classic Bladder Exstrophy: A Long-Term Perspective.

Mahir Maruf1, Roni Manyevitch1, Jason Michaud1

  • 1Robert D. Jeffs Division of Pediatric Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.

The Journal of Urology
|August 23, 2019
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Summary

Most patients with classic bladder exstrophy need multiple surgeries for urinary continence. Bladder neck closure with a catheterizable stoma offers higher continence rates than isolated bladder neck reconstruction.

Keywords:
bladder exstrophyreconstructive surgical procedurestreatment outcomeurinary incontinence

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Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Classic bladder exstrophy presents significant challenges in achieving urinary continence.
  • Successful bladder closure is a prerequisite for subsequent continence procedures.

Purpose of the Study:

  • To investigate surgical approaches for urinary incontinence in classic bladder exstrophy.
  • To evaluate long-term continence outcomes after bladder reconstruction.

Main Methods:

  • Retrospective review of 1,323 patients with exstrophy-epispadias complex.
  • Analysis of 432 patients with classic bladder exstrophy undergoing bladder closure and continence procedures (1975-2017).
  • Procedures included bladder neck reconstruction, augmentation cystoplasty, and continent catheterizable stoma.

Main Results:

  • Continence was achieved in 64% after isolated bladder neck reconstruction (142 patients).
  • Continence was achieved in 93% after bladder neck closure with a continent catheterizable stoma (133 patients).
  • Median follow-up was 7.2 years.

Conclusions:

  • Multiple reconstructive procedures are often necessary for continence in classic bladder exstrophy.
  • Bladder neck closure with a continent catheterizable stoma demonstrates superior continence outcomes.
  • Volitional voiding per urethra is achieved by a minority of patients.