Bladder exstrophy: increase in capacity following epispadias repair.
The achievement of satisfactory continence in the management of classical bladder exstrophy remains a surgical challenge. This may be particularly difficult in the patient with a small bladder capacity after initial closure. The 12-year experience at our institution with bladder exstrophy is reviewed and attention is focused on the approach to those patients with a small bladder capacity. A total of 155 children with bladder exstrophy were treated. Of these 155 patients 28 boys were believed to have a bladder capacity inadequate for satisfactory bladder neck reconstruction (less than 60 cc). All patients have undergone staged reconstruction with a urethroplasty for epispadias and they are available for evaluation. After a median interval of 22 months bladder capacity increased by a median 54.5 cc. No child had hydronephrosis after the epispadias repair or bladder neck reconstruction. Of the 28 patients 25 have undergone bladder neck reconstruction with a median followup of 4.5 years and 88 per cent (22 of 25) demonstrate continence with a dry interval greater than 3 hours. Another 2 patients have been rendered continent following bladder augmentation. These results demonstrate that satisfactory continence is an achievable goal in the exstrophy patient with a small bladder capacity when bladder neck reconstruction is preceded by epispadias repair.
Gearhart
J P
JP
Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Jeffs
R D
RD
D001746:Bladder Exstrophy / Q000503:physiopathology / Q000601:surgery*; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013997:Time Factors; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000517:prevention & control