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

Kufner, M.; Gearhart, John P.; Mathews, Ranjiv

doi:10.1016/j.jpurol.2010.01.007

Cited by 16 publications

(1 citation statement)

References 15 publications

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“…Observed in the Modern Staged Repair of Exstrophy, boys who have an epispadias repair prior to 12 months demonstrate early increases in bladder capacity. 16 Increased resistance and cycling of the bladder appear to play a role in development and it would be interesting to observe the urothelium in this population prior to and after epispadias repair.…”

Section: Discussionmentioning

confidence: 99%

Urothelial Differences in the Exstrophy-Epispadias Complex: Potential Implications for Management

Kasprenski¹,

Michaud²,

Yang

et al. 2021

Journal of Urology

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Purpose:The authors examined the urothelium of exstrophy-epispadias complex spectrum patients for histological differences and expression of terminal markers of urothelial differentiation.Materials and Methods:Between 2012 and 2017 bladder biopsies were obtained from 69 pediatric exstrophy-epispadias complex patients. These specimens were compared to bladder specimens from normal controls. All bladder specimens underwent histological assessment followed by immunohistochemical staining for uroplakin-II and p63. Expression levels of uroplakin-II and p63 were then assessed by a blinded pathologist.Results:Forty-three classic bladder exstrophy biopsies were obtained (10 newborn closures, 22 delayed closures, and 11 repeat closures). Additional biopsies from 18 cloacal exstrophy patients and 8 epispadias patients were also evaluated. These specimens were compared to 8 normal control bladder specimens. Overall, uroplakin-II expression was lower in exstrophy-epispadias complex patients compared to controls (p <0.0001). Among classic bladder exstrophy patients, there was reduced expression of uroplakin-II in the delayed and repeat closures in comparison to newborn closures (p=0.045). Expression of p63 was lower in patients with exstrophy-epispadias complex compared to controls (p <0.0001). Expression of p63 was similar among classic bladder exstrophy patients closed as newborns when compared to delayed or repeat closures. Classic bladder exstrophy patients had a higher rate of squamous metaplasia when compared to controls (p=0.044). Additionally, there was a higher rate of squamous metaplasia in the patients undergoing delayed closure in comparison to those closed in the newborn period (p <0.001).Conclusions:The urothelium in the exstrophy-epispadias complex bladder is strikingly different than that of healthy controls. Uroplakin-II expression is greatly reduced in exstrophy-epispadias complex bladders and is influenced by the timing of bladder closure. Reduced uroplakin-II expression and increased rates of squamous metaplasia in exstrophy-epispadias complex patients undergoing delayed closure suggests that exposure of the urothelium may induce these changes. These findings shed light on the molecular changes in exstrophy-epispadias complex bladders and may have implications on the appropriate timing of primary bladder closure, as those closed in the newborn period appear to have a greater potential for growth and differentiation.

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Section: Discussionmentioning

confidence: 99%