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The multiple reoperative bladder exstrophy closure: what affects the potential of the bladder?
J P Gearhart1, J Ben-Chaim, C Sciortino
1Department of Urology, James Buchanan Brady Urological Institute, The John Hopkins Hospital and School of Medicine, Baltimore, Maryland 21287-2101, USA.
Urology
|February 1, 1996
Summary
Reoperative bladder exstrophy closure is possible in all patients. However, multiple failed closures significantly diminish the chance of achieving adequate bladder capacity for continence.
Area of Science:
- Urology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Bladder exstrophy is a complex congenital anomaly requiring surgical correction.
- Multiple failed closure attempts can compromise bladder development and function.
- Assessing the potential for successful reclosure and future bladder capacity is crucial.
Purpose of the Study:
- To investigate the causes of failure in bladder exstrophy closures.
- To evaluate the bladder's potential after multiple failed closure attempts.
- To identify factors influencing successful reoperation for bladder exstrophy.
Main Methods:
- Retrospective review of 23 patients with bladder exstrophy and ≥2 prior failed closures.
- Analysis of closure techniques, including osteotomy and immobilization.
- Assessment of bladder size and functional outcomes post-reoperation.
Main Results:
- All reoperative repairs achieved success in terms of closure.
- Six patients had adequate bladder size for reconstruction, with 3 achieving continence.
- Nine patients had inadequate bladder size; 8 are under observation for growth.
Conclusions:
- Tension-free closure with osteotomy and immobilization are vital for successful bladder exstrophy repair, regardless of prior attempts.
- Multiple reclosures markedly reduce the likelihood of achieving sufficient bladder capacity for reconstruction and continence.