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

Bladder exstrophy (BE) is a rare congenital anomaly. In resource-limited settings, delayed presentation is common, necessitating augmentation cystoplasty in older children with fibrotic and poorly compliant bladders. The necessity of simultaneous ureteric reimplantation (UR) during augmentation remains debated. The objective of the study is to evaluate long-term renal and urological outcomes in children undergoing complete primary repair of exstrophy (CPRE) with or without UR.

This retrospective study analyzed 51 patients who underwent CPRE with augmentation between 1999 and 2019 and had a minimum follow-up of 5 years. Patients were divided into two groups: Group A (CPRE with UR) and Group B (CPRE only). Surgical details, complications, and follow-up outcomes, including Society of Fetal Urology (SFU) grades of hydronephrosis, renal function, and urinary tract infections (UTIs), were compared. Statistical analysis was performed using the Chi-square test for categorical variables and the t-test and the Mann-Whitney test for continuous variables.

Group A had 24 patients, and Group B had 27 patients. Baseline characteristics, including age, gender distribution, serum creatinine, estimated glomerular filtration rate, and hydronephrosis, exhibited no significant differences between the two groups. No statistically significant differences were observed in rates of postoperative SFU grades of hydronephrosis, UTI, or renal function decline between the groups. While moderate-to-severe hydronephrosis was more common in Group B, this did not translate into worse clinical outcomes.

In delayed BE repair requiring bladder augmentation, omission of UR appears safe and effective. Bladder augmentation alone provides adequate protection of the upper tracts and may simplify surgical planning.