title: Role of urethral bulking agents in epispadias-exstrophy complex patients.
abstract: OBJECTIVE
  Injection of urethral bulking agents (UBA) has been used to increase bladder capacity prior to bladder neck reconstruction (BNR) or as an adjuvant therapy following BNR to improve continence. The purpose of this study was to determine the effectiveness of urethral injections in the exstrophy population.
  
  
  METHODS
  A review was performed of patient characteristics, bladder capacity, and continence status of all patients with the exstrophy-epispadias complex who underwent injection of UBA between 1980 and 2008.
  
  
  RESULTS
  Among 66 patients with a median follow-up of 8 years, 41 underwent injections prior to BNR, and 25 had injections after BNR. Only 24% of patients who underwent injections prior to BNR were continent on last follow-up. Among 25 patients who underwent BNR prior to injection(s), 16 were partially continent and nine were incontinent prior to first injection. Patients who were partially continent attained social continence (dry interval greater than 3 h) at a significantly higher rate than those who were incontinent (63% vs. 13%, p = 0.047). No patient with cloacal exstrophy in either group attained urethral continence.
  
  
  CONCLUSIONS
  UBAs do not appear to have a role prior to BNR. However, they may provide benefit when given adjunctively following BNR in patients who are partially continent.
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7302, Baltimore, MD 21287, USA. Electronic address: bshah52@gmail.com.
authors.forename: Bhavik B
authors.initials: BB
authors.lastname: Shah
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7302, Baltimore, MD 21287, USA.
authors.forename: Eric Z
authors.initials: EZ
authors.lastname: Massanyi
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7302, Baltimore, MD 21287, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Dicarlo
authors.affiliation: The University of Chicago, 5801 South Ellis Avenue, Chicago, IL 60637, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shear
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7302, Baltimore, MD 21287, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Kern
authors.affiliation: Medical University of South Carolina, Department of Urology, 171 Ashley Ave, Charleston, SC 29425, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7302, Baltimore, MD 21287, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D004842:Epispadias / Q000150:complications / Q000601:surgery*; D006801:Humans; D007267:Injections; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*
keywords: Bladder exstrophy; Deflux; Urinary incontinence; Urological surgical procedures