Related Experiment Videos
Urinary continence after reconstruction of classical bladder exstrophy (73 cases)
P Mollard1, P D Mouriquand, X Buttin
1Department of Paediatric Surgery, University Claude-Bernard, Lyon, France.
Insights
Urinary continence after bladder exstrophy reconstruction is unpredictable. Achieving a balance between bladder pressure and outlet resistance is challenging, often requiring further procedures for successful outcomes in children.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Congenital Abnormalities
Background:
- Bladder exstrophy is a complex congenital anomaly requiring multi-stage surgical repair.
- Urinary continence remains a significant challenge after initial reconstruction.
Purpose of the Study:
- To evaluate long-term urinary continence in children following a three-stage repair for classical bladder exstrophy.
- To identify factors influencing continence outcomes and the need for secondary procedures.
Main Methods:
- Retrospective review of 73 children treated between 1966 and 1990.
- Three-stage repair included bladder closure with osteotomy, bladder neck reconstruction (Young-Dees, Jeff's, Mollard techniques), and penile reconstruction.
- Follow-up assessed continence, voiding, residual urine, UTIs, and urinary tract dilatation.
Main Results:
- 69% of patients achieved normal continence with transurethral voiding (girls 77%, boys 63%).
- Persistent incontinence was linked to insufficient outlet resistance, abnormal bladder, or both.
- Secondary procedures like bladder neck reconstruction, augmentation, or Mitrofanoff were performed in complex cases.
Conclusions:
- Bladder neck reconstruction outcomes are unpredictable, with challenges in balancing bladder pressure and outlet resistance.
- Secondary interventions are often necessary to achieve continence.
- The Mitrofanoff procedure provides a safe catheterization option for managing persistent complications.
Objective:
To evaluate urinary continence in children after reconstruction of classical bladder exstrophy.
Patients And Methods:
Seventy-three children were treated between 1966 and 1990 at Debrousse Hospital in Lyon, France. Reconstruction involved a three-stage repair including bladder closure (with posterior iliac osteotomy), bladder neck reconstruction and penile reconstruction.
Results:
Of 73 children with bladder exstrophy, seven underwent an initial urinary diversion and 66 a successful bladder closure at birth combined with posterior iliac osteotomy, 55 of whom underwent a bladder neck reconstruction and anti-reflux procedures. The Young-Dees procedure was performed in four cases, combined with the Jeff's technique in two cases and the Mollard technique in 49. Fifty-four of 55 (22 girls and 32 boys) were followed up for between 1 and 17 years. Results were classified as excellent (37 cases), good (11 cases) or failed (six cases), following assessment of continence, voiding capabilities, residual urine volume, urinary tract infection and urinary tract dilatation. Of these patients 69% had normal continence with transurethral voiding (girls, 77%; boys, 63%). Persistent incontinence after bladder neck reconstruction was related to insufficient outlet resistance, an abnormal bladder or a combination of the two. Repeated bladder neck reconstruction (seven patients), bladder augmentation (five patients), bladder neck suspension (one patient) and bladder neck reconstruction combined with augmentation (five patients) were performed. These operations were coupled with a Mitrofanoff procedure if further complications occurred.
Conclusion:
The outcome of bladder neck reconstruction was unpredictable. Achievement of a balance between intravesical pressure and outlet resistance was difficult and often required secondary endourethral procedures. Persistent incontinence after bladder neck reconstruction was related to insufficient outlet resistance, an abnormal bladder or a combination of the two. Repeated bladder neck reconstruction, bladder augmentation, bladder neck suspension and reconstruction combined with augmentation were performed. These operations were coupled with a Mitrofanoff procedure, which offered catheterization as a safe alternative if further complications occurred.