title: Standing the test of time: long-term outcome of reconstruction of the exstrophy bladder.
abstract: The surgical management of classic bladder exstrophy has evolved over time. Different techniques are used to address the challenge of reconstructing these patients. We review the long-term outcomes of bladder exstrophy treatment from the published literature with regard to urinary continence, voiding and secondary complications. Continence now can be achieved in up to 80% of children in specialist centres. Whether such success can sustained into adult life is uncertain. About 40% of adults are dry in the best hands. Up to 84% of children can void, but there is some evidence that this function is lost with time in 70%. The need for bladder augmentation is widely variable between series, reported in 0-70% of children. This reduces the ability to void spontaneously to about 50% of children. It brings with it the later risk of metabolic disturbance and stone formation. Adults with exstrophy have a 694-fold increase in the risk of bladder cancer by the age of 40 years.
authors.affiliation: The Institute of Urology, University College London, 48, Riding House Street, W1W 7EY, London, UK. Christopher.woodhouse@ucl.ac.uk
authors.forename: C R J
authors.initials: CR
authors.lastname: Woodhouse
authors.forename: Amanda C
authors.initials: AC
authors.lastname: North
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications* / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery