Exstrophy of the bladder progress of management during the last 25 years

The different methods of treatment of bladder exstrophy are described. Ureterosigmoidostomy and its various modifications are discussed and the longterm result critically reviewed. Urinary diversion by transplanting the ureters into an isolated segment of ileum or colon should, in the authors' opinion, only very rarely be necessary. Cutaneous ureterostomy is used only as a last resort in incontinent patients with severe renal damage. The greatest single advance in the management of the malformation has been the two-stage closure of the exstrophic bladder. The authors' experiences in the two-stage closure of 28 patients with ectopia vesicae are described. No selection of patients was practiced. The results obtained, both clinically and by manometry of the operated bladder, are reviewed. The results are moderately satisfactory.