title: Failed exstrophy closure: management and outcome.
abstract: OBJECTIVE
  In a series of failed exstrophy closures, to identify determinants of successful repeat closure and the impact of failed closure on the fate of the lower urinary tract and continence status.
  
  
  METHODS
  We performed a retrospective review of operative notes and medical records of patients with a history of one or more failed exstrophy closures in 1978-2007. The primary surgical endpoints were failure rate of repeat closure attempts, mode of continence surgery and continence outcome. Continence was defined as achieving a dry interval of >3h and voiding through the urethra.
  
  
  RESULTS
  We identified 122 patients (85 male/37 female) who had undergone repeat closure following failure. The success rate of repeat closure attempts at our institution was 98%. Of the 94 patients who had undergone successful repeat closure, definitive continence management and had their dryness evaluated, 38 were candidates for bladder neck reconstruction and 17(18%) were continent. Of the remaining patients, 90% were able to attain dryness, but at the expense of clean intermittent catheterization and continent urinary diversion.
  
  
  CONCLUSIONS
  A failed exstrophy closure has significant implications for long-term surgical outcome. Reclosure can be accomplished in the majority of cases. In comparison to patients with successful primary closure, the rates of urethral continence following successful repeat closure were lower.
authors.affiliation: Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Marburg 149, 600 North Wolfe Street, Baltimore, MD 21287, USA. thomas.novak@amedd.army.mil
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Novak
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Ryan
authors.initials: R
authors.lastname: Orosco
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: Erin
authors.initials: E
authors.lastname: Mack
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D013520:Urologic Surgical Procedures / Q000379:methods