The multiple reoperative bladder exstrophy closure: What affects the potential of the bladder?

To define the possible cause of failure and the eventual potential of the bladder in 23 exstrophy patients, who underwent more than two failed prior attempts at closure. Twenty-three patients were selected from the exstrophy data base who had two or more prior clo- sures. Eighteen patients had under...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 1996-02, Vol.47 (2), p.240-243
Main Authors: Gearhart, John E, Ben-Chaim, Jacob, Sciortino, Christopher, Sponseller, aul D., Jeffs, Robert D.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Bladder Exstrophy - surgery
Epispadias - surgery
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Medical sciences
Osteotomy - methods
Prolapse
Reoperation - methods
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Treatment Outcome
Urinary Bladder - surgery
Urinary Bladder Diseases - surgery
Urinary Diversion
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Summary:To define the possible cause of failure and the eventual potential of the bladder in 23 exstrophy patients, who underwent more than two failed prior attempts at closure. Twenty-three patients were selected from the exstrophy data base who had two or more prior clo- sures. Eighteen patients had undergone 2 previous closures and 5 patients 3 previous closures for either com- plete dehiscence or significant prolapse. At the time of initial closure, 19 patients did not have an osteotomy. At secondary closure, 10 underwent osteotomy while at third closure 5 had an osteotomy. At the time of re- closure at our institution all underwent an osteotomy. Reoperative repair at our institution was successful in all patients. Six patients achieved a bladder size suitable for bladder neck reconstruction and of them 3 are dry. The bladder size was inadequate in 9 pa- tients and 8 are being monitored for possible bladder growth. Tension-free closure with osteotomy and immobilization are important factors both in an initial or any subsequent closure. The chance of obtaining an adequate bladder capacity for bladder neck plasty and eventual continence, following multiple reclosures, is markedly diminished.
ISSN:0090-4295
1527-9995
DOI:10.1016/S0090-4295(99)80424-5