title: Can Classic Bladder Exstrophy be Safely and Successfully Reconstructed at a Low Volume Center?
abstract: OBJECTIVE
  Exstrophy reconstruction is challenging and requires expertise and experience. However, many patients are treated at low volume centers. We evaluated whether classic bladder exstrophy could be safely and successfully reconstructed at a low volume center.
  
  
  METHODS
  A total of 31 patients with classic bladder exstrophy were primarily treated at our low volume center during a 17-year period. A total of 22 patients underwent primary closure within 5 days of birth and 9 underwent delayed closure with osteotomy. Of the patients 29 underwent planned modern staged repair and 2 underwent attempted complete primary repair.
  
  
  RESULTS
  The bladder was successfully closed in all 31 children. All 22 newborns underwent primary bladder closure without osteotomy, including 4 with extremely small bladder plates. Bladder neck obstruction developed in 3 patients (10%), of whom 2 were treated successfully with transurethral dilation and 1 underwent open repair. Epispadias repair was successful in 12 of 15 patients undergoing the Cantwell-Ransley technique and in 2 of 4 undergoing complete primary repair. A total of 16 patients underwent bladder neck reconstruction, of whom 9 are awaiting appropriate age or capacity, 4 were lost to followup, 1 is continent after bladder closure alone and 2 underwent continent diversion (1 after failed bladder neck reconstruction). Of the 15 patients with at least 1 year of followup after bladder neck reconstruction 9 are continent day and night, 2 are continent only during the daytime and 4 are incontinent, for a 73% post-bladder neck reconstruction continence rate (11 of 15 patients).
  
  
  CONCLUSIONS
  Successful exstrophy reconstruction is achievable at a low volume center, with results comparable to those of high volume centers.
authors.affiliation: Pediatric Urology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: benchaim@tlvmc.gov.il.
authors.forename: Jacob
authors.initials: J
authors.lastname: Ben-Chaim
authors.affiliation: Pediatric Urology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Binyamini
authors.affiliation: Pediatric Orthopedics Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eitan
authors.initials: E
authors.lastname: Segev
authors.affiliation: Pediatric Urology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mario
authors.initials: M
authors.lastname: Sofer
authors.affiliation: Pediatric Urology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Bar-Yosef
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D005260:Female; D061846:Hospitals, Low-Volume; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: bladder exstrophy; epispadias; urinary incontinence; urologic surgical procedures