title: Abdominal wall dysfunction in adult bladder exstrophy: a treatable but under-recognized problem.
abstract: Bladder exstrophy is defined by urogenital and skeletal abnormalities with cosmetic and functional deformity of the lower anterior abdominal wall. The primary management objectives have historically been establishment of urinary continence with renal function preservation, reconstruction of functional and cosmetically acceptable external genitalia, and abdominal wall closure of some variety. The literature has focused on the challenges of neonatal approaches to abdominal wall closure; however, there has been a paucity of long-term followup to identify the presence and severity of abdominal wall defects in adulthood. Our goal was to characterize the adult disease and determine effective therapy.
  
  
  
  A retrospective review of a consecutive series of six patients was performed.
  
  
  
  We report and characterize the presence of severe abdominal wall dysfunction in these adult exstrophy patients treated as children. We tailored an abdominal wall and pelvic floor reconstruction with long-term success to highlight a need for awareness of the magnitude of the problem and its solvability.
  
  
  
  The natural history of abdominal wall laxity and the long-term consequences of cloacal exstrophy closure have gone unexplored and unreported. Evaluation of our series facilitates understanding in this complex area and may be valuable for patients who are living limited lives thinking that no solution is available.
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, USA. mmanahan@jhmi.edu.|Johns Hopkins Outpatient Center, 601 North Caroline Street, Baltimore, MD, 21287, USA. mmanahan@jhmi.edu.
authors.forename: M A
authors.identifier: 0000-0002-2907-9029
authors.initials: MA
authors.lastname: Manahan
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Campbell
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Tufaro
mesh_terms: D034861:Abdominal Wall / Q000503:physiopathology* / Q000601:surgery; D062088:Acellular Dermis; D000328:Adult; D001746:Bladder Exstrophy / Q000503:physiopathology* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult
keywords: Abdominal wall reconstruction; Bladder exstrophy; Ventral hernia