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Vesical neck reconstruction in patients with the exstrophy-epispadias complex
D R McMahon1, M P Cain, D A Husmann
1Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, 55905, USA.
The Journal of Urology
|April 1, 1996
Summary
Achieving urinary continence in exstrophy-epispadias complex patients depends on adequate bladder capacity post-reconstruction. Early closure may reduce the need for enterocystoplasty, a common procedure for bladder exstrophy patients.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Genitourinary Medicine
Background:
- The exstrophy-epispadias complex presents significant challenges in achieving urinary continence.
- Vesical neck reconstruction is a key surgical intervention for these patients.
Purpose of the Study:
- To identify critical factors influencing urinary continence in patients with the exstrophy-epispadias complex.
- To evaluate the impact of surgical timing and bladder capacity on continence outcomes.
Main Methods:
- Retrospective review of 51 epispadias and 33 bladder exstrophy cases.
- Analysis of factors including timing of bladder closure, urethroplasty, and bladder capacity.
- Assessment of the role of enterocystoplasty in achieving continence.
Main Results:
- High continence rates were observed: 82% for epispadias and 70% for bladder exstrophy.
- Delayed bladder closure did not impact continence but increased the need for enterocystoplasty.
- Pre-reconstruction bladder capacity did not predict continence or need for augmentation.
Conclusions:
- Adequate bladder capacity post-reconstruction is crucial for urinary continence.
- Preliminary urethroplasty did not improve urinary control.
- Augmentation cystoplasty was required in approximately half of bladder exstrophy patients.