Long term evaluation of continence after complete primary bladder exstrophy repair

Area of Science:

• Pediatric Urology
• Reconstructive Surgery
• Urological Outcomes

Background:

• Urinary continence after bladder exstrophy (BE) repair presents significant challenges for pediatric urologists.
• Standardized definitions and long-term outcome data for BE repair are lacking.

Purpose of the Study:

• To assess long-term urinary continence in patients following a one-stage complete primary repair of bladder exstrophy (CPRE).
• To evaluate the effectiveness of subsequent procedures in achieving a dry interval (DI) of at least 3 hours.

Main Methods:

• Retrospective analysis of 142 toilet-trained patients with BE undergoing one-stage CPRE.
• Surgical techniques included complete penile disassembly (CPD) or modified Cantwell-Ransley repair (MCR) and bilateral anterior transverse innominate osteotomies (ATIO).
• Continence procedures such as endoscopic bladder neck injection (BNI), bladder neck reconstruction (BNR), and bladder neck closure (BNC) were employed as needed.

Main Results:

• Only 16.2% of patients achieved a DI ≥ 3 hours after CPRE alone.
• Complementary procedures were required for the remaining patients, including BNR (22.5%) and BNC with a catheterizable stoma (26.1%).
• A dry interval of ≥ 3 hours was considered an appropriate definition of continence.

Conclusions:

• Successful anatomical closure of BE is achievable, but functional continence outcomes are complex to evaluate.
• CPRE with bilateral ATIO and BNI yields limited continence.
• BNR offers a good chance for continence; otherwise, BNC with a catheterizable stoma is a viable option.