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Late failure of the reconstructed exstrophy bladder
1Institute of Urology, London, UK.
Insights
Long-term bladder closure and reconstruction in bladder exstrophy patients can fail. Late-onset detrusor or urethral failure may occur due to bladder outlet obstruction from neck tightening.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Bladder exstrophy requires surgical reconstruction in infancy.
- Long-term durability of these reconstructions into adulthood is not well-established.
Purpose of the Study:
- To assess the durability of bladder closure and bladder neck reconstruction in adult exstrophy survivors.
- To investigate if bladder outlet obstruction from reconstruction leads to late bladder or urethral failure.
Main Methods:
- Retrospective review of 57 patients with bladder exstrophy diagnosed between 1965 and 1974.
- Analysis of outcomes including need for further surgery or diversion.
Main Results:
- Of 32 reconstructed patients, 13 retained their native bladder into their second decade.
- Eight of these 13 required further surgery for poor bladder compliance, low capacity, or incontinence.
- Two patients retained their native bladder but require self-catheterization.
Conclusions:
- Initially successful exstrophy closures require long-term monitoring.
- Late detrusor or urethral failure can occur, potentially linked to bladder outlet obstruction from bladder neck reconstruction.
Objective:
To establish whether successful bladder closure and bladder neck reconstruction in patients with exstrophy is durable into adulthood and whether bladder outlet obstruction, created during bladder-neck tightening procedures, may lead ultimately to detrusor or urethral failure.
Patients And Methods:
The outcome of 57 patients born with exstrophy between 1965 and 1974 was reviewed.
Results:
Of the 32 babies who underwent reconstruction, 19 failed in childhood and 13 still retained a native bladder into their second decade. Eight of 13 children with successful bladder closures and bladder neck reconstructions required further reconstruction or continent diversion in the second decade of life, most commonly because of poorly compliant, low-capacity bladders associated with incontinence. Six had an augmentation cystoplasty (five with a continence procedure as well) and two had an artificial sphincter alone. Two patients have retained their native bladder but require self-catheterization.
Conclusion:
Long-term follow-up of patients with initially successful exstrophy closures is required, as late detrusor or urethral failure may occur. This detrusor failure may be related to bladder outlet obstruction associated with bladder neck reconstruction.