title: Detrusor wraparound for bladder neck reconstruction in cohort of children with bladder exstrophy.
abstract: OBJECTIVE
  To evaluate the outcome of the detrusor wraparound bladder neck technique of bladder neck reconstruction in 28 children with bladder exstrophy.
  
  
  METHODS
  The records of all patients with bladder exstrophy who underwent detrusor wraparound bladder neck were reviewed. A total of 28 consecutive patients were identified and included 21 boys and 7 girls, with a mean age at surgery of 8.3 years. All patients had undergone previous exstrophy closure (17 staged and 11 complete). Of the 28 patients, 8 (29%) had undergone previous endoscopic injection of a bulking agent at the bladder neck. At surgery, 13 patients (46%) required concomitant ileocystoplasty and a continent outlet. Continence was defined as complete dryness with no urine leakage either through the urethra or the continent outlet.
  
  
  RESULTS
  The mean follow-up duration was 31 months (range 13-48). All augmented patients were continent using clean intermittent catheterization through the outlet. Complete dryness was achieved in 20 (71%) of 28 patients. However, the continence rate was only 47% in the nonaugmented group compared with 100% in the augmented group. Six of the incontinent children underwent bladder neck injection using a bulking agent but dryness was achieved in only 1 (17%).
  
  
  CONCLUSIONS
  The detrusor wraparound bladder neck technique is a viable option for bladder neck reconstruction for incontinent children after exstrophy closure. However, bladder augmentation and continent outlet construction are the pillars of optimal success. Injection of bulking agent at the bladder neck for failure has had poor success.
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. athafez@yahoo.com
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
mesh_terms: D000293:Adolescent; D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012306:Risk; D001743:Urinary Bladder / Q000601:surgery; D014549:Urinary Incontinence; D014551:Urinary Tract / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*