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Long-term Outcomes of Bladder Exstrophy-Epispadias Complex: A Multicenter Study by Indian Association of Pediatric
Kirtikumar J Rathod1, Vikesh Agrawal2, Ramesh Babu3
1Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Insights
Complete primary reconstruction of exstrophy (CPRE) offers superior outcomes for bladder exstrophy-epispadias complex (BEEC) patients compared to other methods. Early surgery and bladder neck reconstruction are key predictors of success in BEEC treatment.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Bladder exstrophy-epispadias complex (BEEC) necessitates complex surgical reconstruction.
- Long-term comparative outcome data from low- and middle-income countries for BEEC are limited.
Purpose of the Study:
- To compare the long-term outcomes of different surgical repair methods for BEEC.
- To identify predictors of successful continence in BEEC patients.
Main Methods:
- A multicenter, retrospective cohort study of 59 BEEC patients (2000-2020) by the Indian Association of Pediatric Surgeons (IAPS).
- Patients were stratified into modern staged repair of exstrophy (MSRE), complete primary reconstruction of exstrophy (CPRE), and radical soft-tissue mobilization (RSTM).
- Outcomes assessed included urinary continence, bladder capacity, complications, reoperations, quality of life (QoL), and predictors of continence.
Main Results:
- CPRE (4.15 ± 1.11) and RSTM (4.0 ± 1.29) showed significantly better continence scores than MSRE (3.02 ± 0.97).
- Acceptable continence (≥4) was achieved in 54.3% of CPRE, 50% of RSTM, and 30% of MSRE patients.
- CPRE demonstrated higher bladder capacity (248.2 cc) and better QoL scores (3.7 ± 1.01) compared to MSRE.
- Early surgery and bladder neck reconstruction were identified as independent predictors of continence.
Conclusions:
- CPRE offers the most favorable long-term outcomes for BEEC, including superior continence, bladder capacity, and QoL.
- RSTM shows promise but requires further investigation in larger cohorts.
- Standardized, prospective surveillance for renal, sexual, and reproductive health in BEEC patients is crucial.
Background:
Bladder exstrophy-epispadias complex (BEEC) requires complex reconstruction, yet long-term comparative outcomes from low- and middle-income countries are limited.
Materials And Methods:
This Indian Association of Pediatric Surgeons (IAPS) multicenter, retrospective cohort study included 59 patients (2000-2020) stratified into modern staged repair of exstrophy (MSRE, n = 20), complete primary reconstruction of exstrophy (CPRE, n = 35), and radical soft-tissue mobilization (RSTM, n = 4). Outcomes included continence (Likert scale 1-5), bladder capacity, complications, reoperations, QoL, and predictors of continence.
Results:
The mean continence score was 3.47 ± 0.97 (95% confidence interval [CI]: 3.22-3.73). CPRE (4.15 ± 1.11) and RSTM (4.0 ± 1.29) significantly outperformed MSRE (3.02 ± 0.97) (Bonferroni: P <0.001). Acceptable continence (≥4) was achieved in 54.3% CPRE, 50% RSTM, and 30% MSRE. Regression analysis showed earlier surgery (β =0.31, P = 0.005), CPRE (β = -0.53, P = 0.013), and bladder neck reconstruction (β = -0.33, P = 0.021) as independent predictors, while osteotomy was not significant (P = 0.35). Mean bladder capacity was 146.4 ± 96.8 cc (95% CI: 121.1-171.6), highest in CPRE (248.2 cc) versus RSTM (152.5 cc) and MSRE (132.1 cc). Complications varied: bladder dehiscence occurred in 40% MSRE versus 5.7% CPRE and 0% RSTM; urinary tract infection/VUR in 12% overall, highest in RSTM (50%); upper tract dilatation in 22.9% CPRE only. Reoperations were required in 45% MSRE versus 51.4% CPRE and 25% RSTM. QoL scores were higher in CPRE (3.7 ± 1.01) and RSTM (3.75 ± 1.24) than MSRE (2.97 ± 0.92). Sexual and reproductive outcomes were poorly documented (<15% assessed).
Conclusion:
CPRE demonstrated the most favorable long-term outcomes, with significantly better continence, higher bladder capacities, fewer reoperations, and superior quality of life compared with MSRE. RSTM yielded encouraging results but requires larger cohorts. This IAPS study identifies early surgery and bladder neck reconstruction as key predictors of success, while underscoring the urgent need for standardized, prospective surveillance of renal, sexual, and reproductive health in BEEC patients and need for longer follow-up.
