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Indications for bladder augmentation in the exstrophy-epispadias complex

R De Castro¹, P Pavanello, R Dòmini

¹Department of Paediatric Surgery, University of Bologna, Italy.

British Journal of Urology

|March 1, 1994

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Bladder augmentation can help avoid urinary diversion in exstrophy-epispadias complex (EEC) patients. This technique improves lifestyle and outcomes in staged reconstruction, though clean intermittent catheterization may be needed.

Area of Science:

Urology
Pediatric Surgery
Reconstructive Surgery

Background:

The exstrophy-epispadias complex (EEC) presents significant challenges in bladder reconstruction.
Urinary diversion is often necessary for managing bladder exstrophy, impacting patient quality of life.

Purpose of the Study:

To evaluate the efficacy of bladder augmentation in avoiding urinary diversion for EEC patients.
To assess improvements in lifestyle and surgical outcomes for patients undergoing staged functional reconstruction.
To determine the role of augmentation cystoplasty in managing complex bladder exstrophy cases.

Main Methods:

A retrospective review of 85 patients treated for EEC between 1970 and 1991.
Detailed analysis of 12 bladder augmentation procedures performed in 11 EEC patients between 1981 and 1991.

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Inclusion criteria covered bladder exstrophy, male epispadias, and cloacal exstrophy.

Main Results:

No significant early surgical complications were reported.
Late complications included bowel obstruction (1), ureteric stenosis (1), and bladder lithiasis (5).
Continence outcomes were generally good, and upper urinary tract status remained satisfactory in most patients.

Conclusions:

Augmentation cystoplasty is a valuable adjunct in EEC treatment, particularly when staged reconstruction fails.
This technique significantly reduces the need for urinary diversion in EEC patients.
While clean intermittent catheterization is often required, patient acceptance is typically high.