Practice patterns in classic bladder exstrophy: A global perspective.

Area of Science:

• Urology
• Pediatric Surgery
• Surgical Practice Patterns

Background:

• Classic bladder exstrophy (CBE) management options are diverse, but global utilization patterns are poorly understood.
• A survey of international exstrophy surgeons was conducted to document current care methods.

Purpose of the Study:

• To investigate and document the global variation in surgical management of classic bladder exstrophy (CBE).
• To identify differences in preoperative, operative, and postoperative management strategies employed by surgeons worldwide.

Main Methods:

• An online survey was distributed to international exstrophy surgeons identified through professional networks.
• Respondents reported practice type, years of experience, and preferred CBE management techniques.
• Surgeons who had not performed a CBE closure in the prior 5 years were excluded from the analysis.

Main Results:

• 217 surgeons from 39 countries responded, representing diverse practice types and experience levels.
• North America showed higher utilization of complete primary repair of exstrophy (CPRE) and oral opioid prescribing compared to other regions.
• While surgeons outside North America favored modern staged repair of exstrophy (MSRE), North American surgeons showed equal preference for CPRE and MSRE.

Conclusions:

• Significant global diversity exists in the surgical management of classic bladder exstrophy (CBE).
• Regional differences in preferred closure techniques (MSRE vs. CPRE) and the use of osteotomies were observed.
• Further comparative studies are needed to determine optimal CBE treatment standards, considering local factors.