Urinary continence after staged bladder reconstruction for cloacal exstrophy: the effect of coexisting neurological abnormalities on urinary continence.
OBJECTIVE
We determined whether there is a difference in the incidence of urinary continence in cloacal and classic bladder exstrophy after staged bladder neck reconstruction using the Young-Dees-Leadbetter technique.


METHODS
We reviewed the records of patients with cloacal and classic bladder exstrophy who underwent staged bladder neck reconstruction from 1971 to 1997.


RESULTS
The Young-Dees-Leadbetter bladder neck reconstruction was completed in 23 patients with cloacal exstrophy, of whom 5 (22%) became continent and 18 (78%) have persistent incontinence. A clinically apparent neurological abnormality significantly hindered the achievement of continence. Specifically 1 of the 13 children (7%) with versus 4 of the 10 (40%) without a neurological abnormality became continent (p <0.05). In contrast, staged reconstruction of classic bladder exstrophy resulted in urinary continence in 67 of the 82 patients (82%). Of the 67 continent patients 23 (34%) cannot void and require intermittent catheterization. None of the patients with classic exstrophy had a neurological deficit.


CONCLUSIONS
The ability of the Young-Dees-Leadbetter bladder neck reconstruction to result in urinary continence significantly differs in the cloacal and classic bladder exstrophy populations (22 versus 82%, p <0.001). Our findings also suggest that a coexisting neurological abnormality significantly hinders the ability to reconstruct a functional bladder in patients with cloacal exstrophy.
Husmann
D A
DA
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Vandersteen
D R
DR
McLorie
G A
GA
Churchill
B M
BM
D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000453:epidemiology*; D013520:Urologic Surgical Procedures / Q000379:methods*