Challenging the need for reimplantation in augmented bladders: Evidence from delayed exstrophy repair

Area of Science:

• Pediatric Urology
• Congenital Anomalies
• Surgical Outcomes

Background:

• Bladder exstrophy (BE) is a rare congenital anomaly often presenting late in resource-limited settings.
• Delayed BE repair frequently requires augmentation cystoplasty for fibrotic, poorly compliant bladders.
• The necessity of simultaneous ureteric reimplantation (UR) during augmentation is debated.

Purpose of the Study:

• To evaluate long-term renal and urological outcomes in children undergoing complete primary repair of exstrophy (CPRE) with or without UR.
• To determine if omitting UR during augmentation cystoplasty impacts outcomes in delayed BE repair.

Main Methods:

• Retrospective analysis of 51 patients undergoing CPRE with augmentation (1999-2019) with ≥5 years follow-up.
• Patients divided into Group A (CPRE with UR) and Group B (CPRE only).
• Comparison of surgical details, complications, SFU hydronephrosis grades, renal function, and UTIs using statistical tests.

Main Results:

• No significant differences in baseline characteristics or postoperative outcomes (hydronephrosis, UTIs, renal function) between groups.
• While moderate-to-severe hydronephrosis was more frequent in Group B (CPRE only), it did not lead to worse clinical outcomes.
• Both CPRE with and without UR demonstrated comparable long-term renal and urological safety.

Conclusions:

• Omission of UR during augmentation cystoplasty for delayed BE repair is safe and effective.
• Bladder augmentation alone adequately protects upper urinary tracts, simplifying surgical planning.
• This approach offers a viable alternative for managing complex bladder exstrophy cases.