title: [Bladder exstrophy: Quality of primary care and long-term prognosis].
abstract: BACKGROUND
  It is universally agreed that successful and gentle initial bladder closure is decisive for favorable long-term outcome. Due to a number of reasons, including a lack of comparable multicenter studies, there are numerous concepts for initial exstrophy closure.
  
  
  CONCLUSIONS
  Therefore, we describe our concept of delayed, staged reconstruction without osteotomy in classical bladder exstrophy, while taking into considerion the available literature on long-term follow-up as well as on own clinical and research data.
  
  
  CONCLUSIONS
  Most notably there are multiple medical but also psychological advantages of a delayed procedure. Primary closure without osteotomy is feasible and has no disadvantages in the long-term follow-up when compared to the invasive procedure of osteotomy. Due to high intravesical pressure, initial bladder neck surgery might have negative effects on bladder development and on the upper urinary tract.
authors.affiliation: Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, Klinik St. Hedwig Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Deutschland. wolfgang.roesch@barmherzige-regensburg.de.
authors.forename: W H
authors.initials: WH
authors.lastname: Rösch
authors.affiliation: Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, Klinik St. Hedwig Regensburg, Steinmetzstr. 1-3, 93049, Regensburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Promm
mesh_terms: D001746:Bladder Exstrophy / Q000175:diagnosis* / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010384:Pelvic Bones / Q000002:abnormalities* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Bladder neck surgery; Initial closure; Long term results; Osteotomy; Urinary tract