J Todd Purves1, Andrew D Baird, John P Gearhart. 1. Division of Pediatric Urology, Department of Urology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Abstract
OBJECTIVE: Many changes have occurred in the treatment of bladder exstrophy over the last few years and several repairs are now offered, but there is a lack of long-term follow-up data. The purpose of this study was to evaluate long-term outcomes in a select group of female patients in whom modern staged repair was undertaken. PATIENTS AND METHODS: From an institutionally approved database 41 patients were identified. All had undergone primary bladder exstrophy closure in 1988-2005, at a mean age of 2 months (range 4h to 3 months), with or without an osteotomy by a single surgeon, and all were followed up for a minimum of 5 years. Twelve patients underwent osteotomy at the time of primary closure. Eight had a classic transverse innominate and vertical iliac osteotomy, and four a transverse innominate only. Mean age at the time of bladder neck repair (BNR) was 4.2 years (39-65 months). Mean measured bladder capacity under gravity cystograms at the time of repair was 109 cc (80-179 cc). RESULTS: Thirty patients (74%) were continent day and night, and voiding per urethra without augmentation or intermittent catheterization. Social continence, defined as dry for more than 3h during the day but damp at night, was found in a further four cases (10%). Seven patients are completely incontinent with dry intervals of less than 1h day and night. The mean time to daytime continence was 12 months (4-16 months) and to night-time continence was 19 months (10-28 months). Patients with a mean capacity greater than 100 cc had better outcomes. Six of the 30 patients achieved dryness after primary closure only, and all six had transverse innominate and vertical iliac osteotomy at the time of primary closure. CONCLUSIONS: Female classic exstrophy patients with a good template who develop adequate capacity after a successful primary closure can achieve acceptable continence without bladder augmentation and intermittent catheterization. A select group will develop continence with closure alone without the need for bladder neck repair.
OBJECTIVE: Many changes have occurred in the treatment of bladder exstrophy over the last few years and several repairs are now offered, but there is a lack of long-term follow-up data. The purpose of this study was to evaluate long-term outcomes in a select group of female patients in whom modern staged repair was undertaken. PATIENTS AND METHODS: From an institutionally approved database 41 patients were identified. All had undergone primary bladder exstrophy closure in 1988-2005, at a mean age of 2 months (range 4h to 3 months), with or without an osteotomy by a single surgeon, and all were followed up for a minimum of 5 years. Twelve patients underwent osteotomy at the time of primary closure. Eight had a classic transverse innominate and vertical iliac osteotomy, and four a transverse innominate only. Mean age at the time of bladder neck repair (BNR) was 4.2 years (39-65 months). Mean measured bladder capacity under gravity cystograms at the time of repair was 109 cc (80-179 cc). RESULTS: Thirty patients (74%) were continent day and night, and voiding per urethra without augmentation or intermittent catheterization. Social continence, defined as dry for more than 3h during the day but damp at night, was found in a further four cases (10%). Seven patients are completely incontinent with dry intervals of less than 1h day and night. The mean time to daytime continence was 12 months (4-16 months) and to night-time continence was 19 months (10-28 months). Patients with a mean capacity greater than 100 cc had better outcomes. Six of the 30 patients achieved dryness after primary closure only, and all six had transverse innominate and vertical iliac osteotomy at the time of primary closure. CONCLUSIONS: Female classic exstrophy patients with a good template who develop adequate capacity after a successful primary closure can achieve acceptable continence without bladder augmentation and intermittent catheterization. A select group will develop continence with closure alone without the need for bladder neck repair.