Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Reconstructive Surgery

Background:

• Bladder exstrophy (BE) presents significant surgical and long-term management challenges.
• Optimizing surgical repair is crucial to minimize complications and maximize functional outcomes.

Purpose of the Study:

• To evaluate short-term complications and intermediate-term continence outcomes following a standardized approach to complete primary repair of exstrophy (CPRE).
• To assess the efficacy of a multi-institutional collaboration utilizing unified surgical principles, real-time coaching, and data analysis.

Main Methods:

• A prospective database collected data from 92 children with classic BE undergoing primary CPRE across three institutions (February 2013 - February 2021).
• Short-term outcomes (within 90 days) and intermediate-term outcomes (minimum 4-year follow-up for patients operated on Feb 2013-Feb 2017) were analyzed.
• Outcomes included surgical complications, upper tract status, vesicoureteral reflux, and bladder voiding/continence status.

Main Results:

• 31% of patients experienced short-term complications within 90 days, necessitating further surgeries in 13 cases.
• No devastating complications like penile injury or bladder dehiscence were observed.
• Intermediate-term follow-up (median 5.7 years) in 40 patients showed 33 voiding volitionally, with 40% achieving >1 hour dry intervals.

Conclusions:

• The standardized CPRE approach shows encouraging intermediate-term continence rates, particularly in boys.
• While short-term complications exist, they are manageable, and the collaborative approach aids in optimizing outcomes for bladder exstrophy.
• Further technique modifications may be needed for girls to address urinary retention concerns.