title: The modern staged repair of classic bladder exstrophy: a detailed postoperative management strategy for primary bladder closure.
abstract: OBJECTIVE
  Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed.
  
  
  METHODS
  Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway.
  
  
  RESULTS
  Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%.
  
  
  CONCLUSIONS
  A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC, USA. stec@musc.edu
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Stec
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.forename: Anthony
authors.initials: A
authors.lastname: Schaeffer
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
authors.forename: Ranjiv I
authors.initials: RI
authors.lastname: Matthews
mesh_terms: D001746:Bladder Exstrophy / Q000175:diagnosis / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006753:Hospital Records / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*