Related Experiment Videos
Epispadias and incontinence: the challenge of the small bladder
C A Peters1, J P Gearhart, R D Jeffs
1Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Epispadias repair in children with small bladder capacity can increase bladder volume. This staged approach, starting with urethroplasty, improves continence rates and reduces the need for bladder augmentation.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Epispadias is a congenital condition often associated with urinary incontinence.
- Small bladder capacity presents a challenge for effective surgical management of epispadias-related incontinence.
Purpose of the Study:
- To review the hospital's 12-year experience managing epispadias and incontinence.
- To evaluate a staged surgical approach for epispadiac children with small bladder capacity.
Main Methods:
- Retrospective review of 29 children with epispadias and incontinence.
- Analysis of outcomes for 15 patients undergoing Young-Dees bladder neck reconstruction.
- Evaluation of 7 patients who had initial urethroplasty for epispadias followed by bladder neck reconstruction.
Main Results:
- Urethroplasty in patients with small bladders increased average capacity by 95 ml.
- Overall continence rate after bladder neck reconstruction was 87% (9/9 boys, 4/6 girls).
- Staged reconstruction group achieved 100% continence in evaluable patients (5/5 boys, 2/2 girls).
Conclusions:
- Urethroplasty prior to bladder neck reconstruction effectively increases bladder capacity in epispadiac children.
- This staged approach can obviate the need for bladder augmentation in many cases.
- The staged approach demonstrates excellent continence outcomes.
Abstract:
The 12-year experience at our hospital with epispadias and incontinence is reviewed and attention is focused on the approach to patients with a small bladder capacity. Of 29 children 20 had incontinence associated with the epispadias (13 boys and 7 girls). A total of 15 patients underwent definitive management of the incontinence with a Young-Dees bladder neck reconstruction with or without ureteral reimplantation and they are evaluable. Nine patients (6 boys and 3 girls) had a bladder capacity that was believed to be inadequate for satisfactory bladder neck reconstruction (less than 60 ml.). To date, 7 of these children have undergone staged reconstruction with urethroplasty for epispadias as the initial operation. Bladder capacity increased 95 ml. on the average (range 60 to 140 ml.) after the urethroplasty. No child had hydronephrosis before or after bladder neck reconstruction. Review of the results of bladder neck reconstruction in all patients with a mean followup of 2.9 years (range 7 months to 13 years) demonstrates an 87 per cent satisfactory continence rate (9 of 9 boys and 4 of 6 girls). In the patients who underwent staged reconstruction the results were similar, with a 100 per cent continence rate in evaluable patients (5 of 5 boys and 2 of 2 girls). In conclusion, urethroplasty before bladder neck reconstruction in the epispadiac child with a small bladder allows an increase in capacity, thus, obviating for the most part the need for procedures such as bladder augmentation in the majority of these patients.