Comparison of preoperative innervation pattern and postreconstructive urodynamics in the exstrophy-epispadias complex

Area of Science:

• Urology
• Pediatric Surgery
• Neuroscience

Background:

• The exstrophy-epispadias complex is often associated with poor bladder outcomes, with neurogenic causes frequently suspected.
• Previous observations suggest favorable outcomes with the Erlangen technique, questioning the role of primary dysinnervation.

Purpose of the Study:

• To investigate the bladder's innervation pattern in children with the exstrophy-epispadias complex using immunocytochemistry and histochemistry.
• To correlate the observed innervation patterns with postoperative bladder function and urodynamic findings.

Main Methods:

• Transmural bladder biopsies from 22 children undergoing reconstructive surgery were analyzed for neuronal markers (VIP, NPY, SP, CGRP, PGP 9.5) and NADPHd.
• Control biopsies from 6 healthy bladders were used for comparison.
• Urodynamic studies were performed on 19 patients post-reconstruction.

Main Results:

• No morphological or urodynamic evidence of dysinnervation was found in isolated epispadias and classical exstrophy.
• Exstrophy cases with prior failed reconstruction showed muscular innervation deficiencies but increased sub/intraepithelial innervation, correlating with bladder instability.
• Cloacal exstrophies and 'transition forms' exhibited significantly abnormal and uneven innervation patterns, linked to poor bladder capacity, compliance, and detrusor function.

Conclusions:

• Primary dysinnervation is not evident in isolated epispadias or classical exstrophy.
• Complex forms of exstrophy, particularly cloacal exstrophy and 'transition forms', present with distinct and pathological innervation patterns.
• The prognosis for bladder function in cloacal exstrophy and 'transition forms' remains uncertain due to these severe innervation abnormalities.