title: Evaluation of need for salvage continence procedures after failed modern staged repair.
abstract: OBJECTIVE
  To assess our experience with salvage continence procedures in patients with bladder exstrophy.
  
  
  METHODS
  We retrospectively reviewed our surgical records of patients with bladder exstrophy who had undergone failed modern staged repair elsewhere and underwent salvage continence operations at our institute from 1996 to 2008.
  
  
  RESULTS
  A total of 16 patients had undergone salvage continence operations. Bladder augmentation was performed in 11 patients (68.8%); 14 children (87.5%) received a continent, catheterizable stoma. In 6 children (37.5%) bladder neck injections were done. Three patients (18.8%) underwent bladder neck closure combined with other reconstructive procedures. A total of 49 continence procedures were performed, with an average of 3.06 per patient. We included all 16 children >5 years. After these operations, 13 of 16 (81.3%) became continent. Two children were able to void spontaneously and were dry day and night (12.5%). Of the remaining 14 patients, all of whom used clean intermittent catheterization, 11 (68.7%) were continent during the day and night with augmentation and/or a catheterizable stoma. Three patients were incontinent (18.7%).
  
  
  CONCLUSIONS
  Although the need to perform salvage continence procedures after failed bladder modern staged repair is high, when patients are appropriately selected, continence can be achieved eventually.
authors.affiliation: Department of Pediatric Urology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma 73104, USA. Yusuf-kibar@ouhsc.edu
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Kibar
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Roth
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ashley
authors.forename: Dominic
authors.initials: D
authors.lastname: Frimberger
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Kropp
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D012189:Retrospective Studies; D017211:Treatment Failure; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult