The lessons of 40 bladder extrophies in 20 years

A personal series of 42 consecutive unselected bladder extrophies over a 20-year period is critically analyzed. The incidence is calculated as 1 in 25,000 live births. Four died unoperated of multiple anomalies and two died following surgery. Of the remaining 36, cosmetic closure was possible in 34. Most closures were done at about 1 year, though 1 month of age is now preferred. Iliac osteotomy has been abandoned. Further staged surgery using Young-Dees bladderneck reconstruction and ureteric reimplant high in the bladder has been used in 11 selected cases. It has been effective in five but there have been three bilateral ureteric obstructions in small bladders. Twelve patients are under 5 years of age and considered too young for definitive evaluation. Of 22 patients available for close analysis, three and possibly four will be acceptably dry. Twelve have had colon or ileal loop diversion and a further two are awaiting diversion. Three are wet. On our experience we hope to successfully reconstruct about one in five unselected extrophies. For the remainder, ureteric transplant into an isolated colon loop offers the most options for the future. The selection of cases and criteria of continence in young children are important considerations in assessing results.