Bladder capacity as a predictor of voided continence after failed exstrophy closure.
OBJECTIVE
To evaluate potential predictors of voided continence among bladder exstrophy patients with a history of a failed closure.


METHODS
The authors reviewed all patients who underwent a bladder neck reconstruction (BNR) with a history of one or more failed exstrophy closures between 1979 and 2007. The following data were collected for each patient: number of failures, site of surgery, mode of failure, presence of osteotomy, bladder capacity, need for additional procedures, and continence status.


RESULTS
Among patients who underwent successful reclosure following one or more failed closures, 52 patients underwent BNR, and 24 (46%) were continent at last follow-up. Bladder capacity was the only variable predictive of voided continence. The median bladder capacity at the time of BNR differed between those who achieved continence (100 mL) and those who did not (65 mL) (p = 0.005). ROC analysis showed an optimal pre-BNR bladder capacity cutoff for predicting future BNR success of between 80 and 100 mL.


CONCLUSIONS
As previously shown in patients with successful primary closure of exstrophy, these data suggest that bladder capacity also has predictive value in the success of BNR after failed exstrophy closure.
The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7304, Baltimore, MD 21287, USA. Electronic address: emassan1@jhmi.edu.
Eric Z
EZ
Massanyi
The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7304, Baltimore, MD 21287, USA.
Bhavik B
BB
Shah
Medical University of South Carolina, Department of Urology, 171 Ashley Ave, Charleston, SC 29425, USA.
Nima
N
Baradaran
The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7304, Baltimore, MD 21287, USA.
John P
JP
Gearhart
D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009929:Organ Size; D012372:ROC Curve; D017211:Treatment Failure; D001743:Urinary Bladder / Q000473:pathology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D014554:Urination; D013520:Urologic Surgical Procedures
Bladder exstrophy; Bladder neck reconstruction; Failed closure