Long‐term results of bladder neck reconstruction for incontinence in children with classical bladder exstrophy or incontinent epispadias

Abstract

OBJECTIVETo review the long-term results of bladder neck reconstruction (BNR) in patients with classical bladder exstrophy or epispadias, and to review the concept of continence surgery in these two groups, stressing the difficulty in finding an adequate balance between urine storage (which implies high outlet resistance and low storage pressure) and complete bladder emptying (which implies low outlet resistance and a transient increase in bladder pressure); surgery cannot achieve 'continence' (which implies active mechanisms) but only 'dryness' (which implies passive mechanisms). PATIENTS AND METHODSEighty patients with classical bladder exstrophy (52 male, 28 female) and 25 with incontinent epispadias (17 male, 18 female) had their bladder neck reconstructed after a Young-Dees-Leadbetter procedure, subsequently modified by Mollard. The treatment is detailed and results reviewed after a mean follow-up of 11 years. All patients were treated and followed in the same institution. RESULTSIn the exstrophy group, 36 (45%) patients presented with a dry interval of >3 h, with urethral emptying after one BNR; 52 (65%) presented with recurrent urinary tract infections, 19 (24%) with urinary stones, 21 (26%) with dilated upper urinary tracts, 13 (16%) with bladder perforations and one with an adenocarcinoma of the bladder. Thirtyeight patients (48%) required further surgery; 51% of all patients required an endoscopic procedure within 3 months after the BNR and 26% had endoscopic procedures for late (> 3 months) urine retention. In the epispadias group, 13 (52%) patients presented with a dry interval of >3 h with urethral emptying after one BNR; 12 (48%) had recurrent urinary tract infections, five (20%) upper tract dilatation, two (8%) bladder stones, one (4%) bladder perforation and one an adenocarcinoma of the bowels after a ureterosigmoidostomy. Ten (40%) children required further surgery. CONCLUSIONWe compared the present results for continence with those in other published series; most complications encountered were related to the obstructive pattern of bladder

Contemporary outcomes in bladder exstrophy

“…Although some have debated as to whether an augmented bladder predisposes to bladder stone formation [14] most of the literature would agree that an augmented bladder is a risk factor for bladder calculi. In the series by Shaw et al [13], bladder calculi formed in 72% of patients who had undergone bladder augmentation and in the paper by Mouriquand et al [15] there was a 24% incidence of bladder calculi in augmented patients. Bladder perforations were more common in patients who had undergone augmentation in Shaw's series, with all patients who perforated having had an augment.…”

Short and long-term quality of life after reconstruction of bladder exstrophy in infancy: preliminary results of the QUALEX (QUAlity of Life of bladder EXstrophy) study

“…Long-term results are judged in continence [1], aesthetic results, sexual function [2,3], and fertility [4]-the mains aspects that can impact on quality of life (QOL) throughout the patient's life. Many studies have been published reporting the long-term outcome of reconstruction [5][6][7][8] to assess which kind of reconstruction gives the best results in continence or sexual function [9].…”

Outcome of continence procedures after failed endoscopic treatment with dextranomer-based implants (DEFLUX®)

“…Iterative endoscopic treatments in these patients have a very limited success rate. Mouriquand [10] 80 61% 100% Lottmann [11] 63 67% 100% Baka-Jakubiak [12] 73 82% 85% Baird [13] 67 80% 70% Current series 9 78% 71% …”