One-Stage Delayed Bladder Exstrophy Closure Combined With Kelly Repair: Early Outcomes Following the 100-Case...

Area of Science:

• Pediatric Surgery
• Urology
• Congenital Abnormalities

Background:

• Bladder exstrophy and cloacal exstrophy are complex congenital anomalies requiring specialized surgical management.
• One-stage delayed closure aims to improve outcomes by allowing for growth and development before reconstruction.

Purpose of the Study:

• To evaluate the incidence of bladder dehiscence after a one-stage delayed closure of bladder/cloacal exstrophy.
• To assess early complications associated with this surgical approach, combining bladder plate closure with the Kelly procedure.

Main Methods:

• A multicenter retrospective study included 123 children with bladder or cloacal exstrophy undergoing single-stage closure with Kelly mobilization.
• The primary endpoint was bladder dehiscence within 3 months post-surgery; secondary endpoints included early complications.
• Outcomes were analyzed for primary repairs and complex cases, with a median follow-up of 54 months.

Main Results:

• No cases of bladder dehiscence were observed in the 123 patients.
• Early complications occurred in 19% of patients, predominantly wound-related (12%) and urinary fistulas (7%).
• Abdominal closure using rectus abdominis muscle transposition was identified as an independent risk factor for wound complications (OR 4.47, p=0.02).

Conclusions:

• Single-stage delayed closure combined with Kelly mobilization provides reliable bladder closure for bladder/cloacal exstrophy with no early dehiscence.
• The overall early morbidity rate was less than 20%, with most complications being low-grade.
• For challenging pubic approximations, osteotomies or fascial flaps may yield better early parietal outcomes than rectus muscle transposition.