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One-stage reconstruction of bladder exstrophy
J Fuchs1, S Glüer, H Mildenberger
1Department of Pediatric Surgery, Hannover Medical School, Germany.
Insights
Primary one-stage bladder exstrophy reconstruction achieved good cosmetic results and continence in most infants. This approach offers potential advantages over staged procedures for bladder exstrophy repair.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Congenital Abnormalities
Background:
- Bladder exstrophy is a complex congenital anomaly requiring surgical correction.
- Traditional staged repair methods have varying success rates.
- A primary one-stage reconstruction offers an alternative approach.
Purpose of the Study:
- To evaluate the outcomes of a primary one-stage reconstruction for bladder exstrophy.
- To assess cosmetic and functional results, including urinary continence and renal function.
- To compare the one-stage approach with staged procedures.
Main Methods:
- A cohort of 15 infants underwent primary one-stage bladder exstrophy reconstruction.
- Procedures included ureteral reimplantation, bladder neck reconstruction, bladder closure, symphyseal approximation, abdominal wall closure, and epispadias repair.
- Postoperative immobilization and follow-up assessments (clinical, uroflowmetry, imaging) were performed.
Main Results:
- All patients achieved satisfactory cosmetic results.
- Complete urinary continence was achieved in 8/15, partial continence in 5/15, and incontinence in 2/15.
- Bladder capacity exceeded 100 ml in 11/15 patients; renal function remained normal in all.
- Iliac osteotomy did not impact functional or cosmetic outcomes but was associated with pelvic asymmetry in two cases.
Conclusions:
- Primary one-stage reconstruction for bladder exstrophy yields acceptable functional and cosmetic outcomes.
- This approach demonstrates a favorable success rate compared to staged procedures.
- The one-stage method may offer advantages for patients with bladder exstrophy.
Abstract:
From 1984 to 1990 a primary one-stage reconstruction of bladder exstrophy was performed at our hospital on 15 consecutive infants. Reconstruction included Cohen's ureteral reimplantation, bladder neck reconstruction according to Young-Dees, bladder closure, symphyseal bone approximation, abdominal wall closure, and repair of epispadias in females. Postoperatively, all patients were immobilized by overhead extension. Iliac osteotomy was done in 9 children, but was abandoned in recent years for infants less than one month old Follow-up examinations included an interview with the parents, clinical examinations, blood and urine analyses, uroflowmetry, and ultrasound scan of the abdomen. Nuclear renal scan, i.v. pyelography, and cystography were carried out as indicated. At the time of last evaluation the children were between 3 and 9 years of age. The cosmetic results were satisfactory in all cases. Eight of 15 children were dry day and night with micturition intervals more than 3 hours during day time (complete continence). Five children were dry during day time with micturition intervals up to 3 hours, but occasionally wet their beds (partial continence). Two children were incontinent. Eleven of 15 children had a bladder capacity of more than 100 ml. Renal function was normal in all patients. Two children showed a mild VUR, and no other abnormalities of the upper urinary tracts were found. Iliac osteotomy did not influence the functional or cosmetic results, but in two patients asymmetry of pelvic bones with consecutive lumbar scoliosis was found. Comparing these results with reports on staged reconstructive procedures, we conclude that by primary complete one-stage reconstruction a well acceptable success rate is achieved, and that by this method possibly some advantages are offered to patients with bladder exstrophy.