title: An initial report of a novel multi-institutional bladder exstrophy consortium: a collaboration focused on primary surgery and subsequent care.
abstract: OBJECTIVE
  For bladder exstrophy repair it is universally accepted that successful initial surgery is paramount to achieve the optimal outcome. Gaining the necessary surgical experience is challenging due to the rarity of bladder exstrophy. We report preliminary findings of a multi-institutional collaboration created to increase experience and proficiency with the care of bladder exstrophy.
  
  
  METHODS
  Our 3 institutions alternatively served as the host site for scheduled surgeries with observation, commentary and critique by visitors from the other sites. The technique was complete primary repair with bilateral iliac osteotomy. The timing of complete primary repair at age 1 to 3 months facilitated collaboration. We recorded patient demographics and outcomes, and the impact of this collaboration on our technique and experience. Video recording was used for real-time observation and teaching, and future analysis, editing and review.
  
  
  RESULTS
  A total of 16 site visits occurred from February 2013 through May 2014. Complete primary repair was performed in 9 males and 7 females with bladder exstrophy. Median age at complete primary repair was 2 months (range 0.1 to 28.8). Median followup was 8.9 months (range 2.8 to 18.2). All closures were successful with no dehiscence. Complications included urethrocutaneous fistula in 2 patients, 1 episode of pyelonephritis in 3 each and urethral obstruction in 2 females, of whom 1 required clean intermittent catheterization.
  
  
  CONCLUSIONS
  We report a multi-institutional collaboration to standardize the surgical management of bladder exstrophy. This effort increased the annual experience of each institution involved from threefold to ninefold and it has accelerated the physician knowledge base to ultimately benefit patient care.
authors: Department of Urology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: joseph.borer@childrens.harvard.edu.
authors: Joseph G
authors: JG
authors: Borer
authors: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors: Evalynn
authors: E
authors: Vasquez
authors: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Douglas A
authors: DA
authors: Canning
authors: Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors: John V
authors: JV
authors: Kryger
authors: Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors: Michael E
authors: ME
authors: Mitchell
mesh_terms: D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D058996:Quality Improvement / Q000458:organization & administration; D013519:Urogenital Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: bladder exstrophy; clinical competence; quality improvement; reconstructive surgical procedures; surgeons