One stage functional reconstruction of exstrophied bladder: report of two cases with six-year follow-up.

Two female babies aged 8 and 13 mo., affected with bladder exstrophy, were submitted to a single-stage functional reconstruction of the bladder. Innominate osteotomy, bladder closure, anti-reflux procedure and narrowing of the bladder outlet followed by pubic reapproximation and easy closure of the abdominal wall were performed in one session. Bladder enlargment and a steadily improving continence occurred in the first case with no reflux and no urinary infection. Further surgery may not be needed if full urinary control can be achieved through active cooperation by the patient. Postoperative continence was achieved in the second patient with a secondary operation on the bladder outlet and pedicled muscle transplant. The absence of reflux, infection and pyelonephritis dis warrant a safe and definite bladder enlargement, with a very satisfactory functional result. An anti-reflux procedure should always be performed at the time of bladder reconstruction in babies older than 3 or 4 months.