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Updated: Jul 18, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long term evaluation of continence after complete primary bladder exstrophy repair
Hisham M Hammouda1, Ahmed A Shahat1, Nariman Abol Oyoun2
1Urology Department Pediatric Urology Division, Assiut University, Assiut, Egypt.
Insights
Achieving urinary continence after bladder exstrophy (BE) repair is challenging. While complete primary repair of bladder exstrophy (CPRE) is feasible, bladder neck reconstruction or closure with a catheterizable stoma may be necessary for long-term continence.
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.
Introduction:
Continence after bladder exstrophy (BE) repair remains a major debatable challenge to pediatric urologists, together with the lack of standard definitions and long-term results in large series.
Objective:
We assessed the long-term urinary continence in 142 toilet-trained cases after one (1-) stage of complete primary repair of bladder exstrophy (CPRE) and consequent procedures to achieve this goal in a single tertiary referral center.
Study Design:
The current retrospective study included 123 boys and 19 girls with BE that were repaired by (1-) stage CPRE. The Mean age at (BE) repair was 9.5 ± 2.6 weeks. Complete penile disassembly (CPD) was used for epispadias repair in 42 (34.1%) and modified Cantwell-Ransley repair (MCR) was used in 81 (65.9%) boys. Bilateral anterior transverse innominate osteotomies (ATIO) were applied in all. Urinary continence was expressed in terms of the dry interval (DI). Continence procedures were afforded if CPRE failed to achieve DI ≥ 3 h (hrs.), those were in the form of endoscopic bladder neck injection (BNI), bladder neck reconstruction (BNR), and bladder neck closure (BNC) with catheterizable stoma.
Results:
The mean age at follow up was 12.1 ± 5.2 years. DI ≥ 3 h was gained in 23 (16.2%) after CPRE alone, while complementary post-CPRE continence procedures were required to reach this goal in the remaining patients. Deflux injection was reported in 10 (7%), CIC in 8 (5.6%), BNR in 32 (22.5), and BNC with catheterizable stoma alone in 37 (26.1%), or with Charleston pouch in 32 (22.5%).
Discussion:
We think that ≥3 h DI with voiding represents an appropriate definition of continence after BE repair. According to the results in the current series, we think that successful anatomical closure of BE is achievable, but the functional outcome in terms of continence and its evaluation is tricky. Results of continence were reported to change with age of the child, and it is difficult to evaluate both before toilet training age and long-term follow up.
Conclusions:
Long-term follow up of CPRE with bilateral ATIO alone or with BNI results in ≥3 h DI in a few cases; BNR after CPRE can provide a good chance for continence; otherwise, BNC with catheterizable stoma is a valid option.
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