title: Exstrophy-epispadias complex presenting in adulthood: a single-center review of presentation, management, and outcomes.
abstract: OBJECTIVE
  To study the presentation, management, and outcome of patients with exstrophy-epispadias complex, who present in adulthood (aged >18 years).
  
  
  METHODS
  A retrospective review of the electronic medical records of patients with exstrophy-epispadias complex managed from January 2001 to December 2010 was undertaken. Patients aged >18 years at presentation, with detailed medical records were selected. They were classified into 2 groups: group A (previously untreated) and group B (residual defects or complications after childhood surgery).
  
  
  RESULTS
  Thirty-nine patients with exstrophy-epispadias complex presented to our institution over this 10-year period. Of these 26 were adults (aged >18 years; range, 18-48 years). Detailed medical records could be obtained for 21 of them and they were included. Group A consisted of 4 patients--2 male and 2 female. All underwent cystectomy; 2 had an ileal conduit and 2 had ureterosigmoidostomy (Mainz II). All had improved quality of life and a stable renal function at follow-up. Group B consisted of 17 patients. Mean number of surgeries attempted previously was 4.4 (range, 2-13). Presentation was varied but primarily involved incontinence of urine (n = 12). Four patients were lost to follow-up, 2 were managed conservatively, and 11 underwent a surgical procedure. All patients returned to normal activity with an improvement in the quality of life postoperatively.
  
  
  CONCLUSIONS
  Exstrophy-epispadias complex is difficult to manage in resource-poor settings associated with illiteracy and poverty. However, successful rehabilitation and an improved quality of life are possible even in cases presenting in adults.
authors.affiliation: Department of Urology, Christian Medical College, Vellore, India. Electronic address: docvivek@gmail.com.
authors.forename: Vivek
authors.initials: V
authors.lastname: Venkatramani
authors.affiliation: Department of Urology, Christian Medical College, Vellore, India.
authors.forename: J
authors.initials: J
authors.lastname: Chandrasingh
authors.affiliation: Department of Urology, Christian Medical College, Vellore, India.
authors.forename: Antony
authors.initials: A
authors.lastname: Devasia
authors.affiliation: Department of Urology, Christian Medical College, Vellore, India.
authors.forename: Nitin S
authors.initials: NS
authors.lastname: Kekre
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001746:Bladder Exstrophy / Q000175:diagnosis / Q000601:surgery*; D004842:Epispadias / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult