title: Bladder growth and development after complete primary repair of bladder exstrophy in the newborn with comparison to staged approach.
abstract: OBJECTIVE
  We assessed bladder growth and dynamics following complete primary repair of bladder exstrophy (CPRE) compared to the staged approach.
  
  
  METHODS
  We reviewed the records of 16 boys and 7 girls who underwent CPRE within 3 days of life from 1996 to 2004 and compared them to the records of 8 boys and 6 girls treated with a staged repair from 1979 to 1996. Screening methods included voiding cystourethrogram, radionuclide cystogram and urodynamic study. We estimated growth curves for bladder capacity following repair in each group, and compared percent predicted bladder capacity (PPBC), compliance and detrusor overactivity between the CPRE and staged repair groups following bladder neck reconstruction.
  
  
  RESULTS
  Bladder capacity in the staged repair group was 69.8 ml (95% CI 46.7-104.4) immediately after bladder neck reconstruction and increased by 15.0% per year thereafter (95% CI 6.2-24.5, p = 0.002). In the CPRE group bladder capacity was 29.0 ml (95% CI 21.3-39.5) initially and increased by 28.9% per year thereafter (95% CI 17.4-41.5, p <0.001). PPBC started at 45.6% (95% CI 35.7-55.5) and increased 1.2% per year (95% CI -1.1-3.5, p = 0.29) following repair for all genders and surgery groups. Compliance was 124.4% (95% CI 22.6-310.7, p = 0.01) greater in the CPRE group at all times following repair. Detrusor overactivity was present in 0 of 19 patients in the CPRE group and 6 of 13 (46%) in the staged group (exact p = 0.002).
  
  
  CONCLUSIONS
  Within the CPRE group bladder stability was universal, and sphincter electromyography was normal suggesting no neuromuscular compromise of the pelvic floor. At early followup, our results suggest that PPBC is equivalent irrespective of gender or management. Further objective evaluation is needed in both groups.
authors.affiliation: Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA. joseph.borer@childrens.harvard.edu
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.forename: Patricio C
authors.initials: PC
authors.lastname: Gargollo
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Kinnamon
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Bauer
authors.forename: Shahram
authors.initials: S
authors.lastname: Khoshbin
authors.forename: W Hardy
authors.initials: WH
authors.lastname: Hendren
authors.forename: Craig A
authors.initials: CA
authors.lastname: Peters
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.forename: Anthony
authors.initials: A
authors.lastname: Atala
authors.forename: Sandy
authors.initials: S
authors.lastname: Chin
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
mesh_terms: D001746:Bladder Exstrophy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000254:growth & development* / Q000503:physiopathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*