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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
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Complete primary repair of bladder exstrophy: a systematic review
Piyush Pathak1, Joshua D Ring1, Kristin R Delfino1
1Southern Illinois University School of Medicine, Springfield, IL, USA.
Journal of Pediatric Urology
|March 8, 2020
Summary
Complete primary repair of exstrophy (CPRE) aims to reduce procedures for bladder exstrophy (BE) reconstruction. However, this review indicates most patients still need multiple surgeries for complete reconstruction and continence.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
Background:
- Bladder exstrophy (BE) is a complex congenital anomaly requiring surgical correction.
- Complete primary repair of exstrophy (CPRE) was introduced to simplify BE management.
- CPRE is considered by some as an alternative to traditional staged repair.
Purpose of the Study:
- To evaluate if Complete Primary Repair of Exstrophy (CPRE) reduces the number of procedures needed for bladder exstrophy (BE) reconstruction.
- To assess the outcomes and complications associated with CPRE.
Main Methods:
- A systematic review of literature from 1989 to 2016 was conducted.
- Eleven articles evaluating outcomes of patients undergoing CPRE were analyzed.
- Data on age at closure, complications, additional procedures, and outcomes were extracted.
Main Results:
- Ten groups reported on CPRE for 236 patients (153 boys, 72 girls).
- Most patients required additional procedures, including ureteral reimplantation (58 patients), hypospadias repair, and bladder neck reconstruction (BNR) for continence.
- Successful voiding without BNR was achieved in only 16-37% of children.
Conclusions:
- CPRE, while proposed as a single-stage procedure for bladder exstrophy, often necessitates multiple surgical interventions.
- Most patients undergoing CPRE require further procedures to achieve complete reconstruction and urinary continence.
