Cystometric evaluation of reconstructed classical bladder exstrophy

Abstract

Objective To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy. Patients and methods Thirty-one patients with bladder exstrophy were assessed 1 year after a modi®ed bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto-urethrography, ultrasonography and arti®cial slow-®lling cystometry. Results Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of <20 cmH 2 O, was signi®cantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty-one patients could initiate a detrusor contraction during voiding. The residual volume was signi®cant in nine of the 21 patients who attempted to void. Patients with a high end-®ll pressure (>40 cmH 2 O) had a signi®cantly higher incidence of unobstructive hydronephrosis than had patients who had an end-®ll pressure of <40 cmH 2 O. Conclusions Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end-®ll pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment.

Impact of epispadias repair on bladder growth in boys with classic bladder exstrophy

“…The data however do support the concept that there may be optimal time intervals for the various stages of reconstruction that would lead to best outcomes in children with classical exstrophy. Even in patients who have achieved successful reconstruction, long-term follow-up of the upper tracts is recommended [14].…”