Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence.

To determine what factors could affect the success of initial bladder closure in classical bladder exstrophy, 80 patients who have completed staged bladder reconstruction were reviewed. Evaluations comparing early bladder closure performed with or without bilateral iliac osteotomy versus delayed closure performed with iliac osteotomy revealed no statistical difference among the 3 populations in regard to the development of bladder dehiscence or onset of urinary continence (p greater than 0.5). Individuals undergoing delayed bladder closure without iliac osteotomy had no notable difference in the incidence of bladder dehiscence (p greater than 0.5) but they had a statistically significant difference in the ability to gain urinary continence (p less than 0.01). Bladder prolapse, abdominal distension or loss of urinary drainage catheters was significantly related to bladder dehiscence (p less than 0.02). Urinary continence was obtained in 75 per cent of the patients with successful bladder closure, compared to 30 per cent if the initial closure dehisced (p less than 0.01).