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Related Experiment Videos

Techniques to create continence in the failed bladder exstrophy closure patient

J P Gearhart1, D A Canning, D S Peppas

  • 1Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Urology
|August 1, 1993
PubMed
Summary
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Children with bladder exstrophy who failed initial closure can achieve urinary continence and maintain stable renal function through reconstructive surgery. Salvage procedures, often involving augmentation and intermittent catheterization, are effective for achieving dryness.

Area of Science:

  • Pediatric Urology
  • Reconstructive Surgery

Background:

  • Bladder exstrophy is a complex congenital anomaly requiring surgical correction.
  • Failure of primary bladder closure presents significant challenges for achieving urinary continence.

Purpose of the Study:

  • To evaluate the outcomes of reconstructive procedures in patients with bladder exstrophy who failed primary closure.
  • To assess the effectiveness of salvage techniques in achieving urinary continence and preserving renal function.

Main Methods:

  • Retrospective review of 315 patients with bladder exstrophy treated between 1976 and 1992.
  • Analysis of 47 patients who required reclosure and 28 who underwent procedures for urinary continence.
  • Categorization of reconstructive methods including bladder neck reconstruction, augmentation, and continent stoma creation.

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Main Results:

  • Various reconstructive techniques, including bladder neck reconstruction and augmentation, were employed to achieve dryness.
  • A significant proportion of patients achieved continence with intermittent catheterization or spontaneous voiding.
  • Salvage procedures resulted in stable renal function, with only one patient experiencing upper tract changes.

Conclusions:

  • Children who fail initial bladder exstrophy closure can achieve continence and maintain stable renal function with appropriate reconstructive surgery.
  • Augmentation and intermittent catheterization are often necessary for achieving dryness in these complex cases.
  • A variety of surgical techniques can be successfully applied to manage bladder exstrophy failures.