A Collaborative Model For Bladder Exstrophy Care: A Retrospective Review of Surgical Outcomes, Urinary Continence,...

We report the surgical outcomes of a nine-year collaborative model for managing a predominantly previously operated cohort of patients with bladder exstrophy (BE).

We retrospectively reviewed patients with classic BE managed between 2016-2024 during annual collaborative surgical missions. Patients with ≥1 year follow-up were included. Surgical management was individualized and included bladder closure (BC), bladder neck reconstruction (BNR), bladder neck injection (BNI), bladder neck closure (BNC), bladder augmentation (BA), and continent urinary diversion (CUD). Follow-up combined in-person care with telemedicine. Outcomes included continence (volitional voiding ≥3 hours), dryness (≥3 hours with clean intermittent catheterization), complications, and renal function.

Fifty-five patients were included, 80% of whom had undergone previous reconstruction. Initial procedures included primary BC (n=11), redo BC (n=11), BNR without CUD (n=15), BNR with CUD with/without BA (n=6), BNC with CUD and BA (n=7), and BNI (n=5). At last follow-up, 11 patients (20%) had undergone additional continence surgeries. All primary BCs performed by our team were successful. Following the last major continence procedure, BNR without CUD achieved 36.4% continence and 3% dryness, BNR with CUD (±BA) achieved 66.7% dryness, and BNC with CUD and BA achieved 90% dryness. Overall, 47.3% of patients achieved continence or dryness. Postoperative complications occurred in 30.9% of patients, and no patient developed renal failure.

A structured collaborative model can deliver outcomes comparable to high-income settings, even in complex, previously operated patients. Individualized surgical planning combined with hybrid follow-up provides a practical and potentially scalable model for delivering specialized BE care.