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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.
British Journal of Urology
|March 1, 1994
Summary
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.