The modern staged repair of classic bladder exstrophy: A detailed postoperative management strategy for primary bladder closure

Stec, Andrew A.; Baradaran, Nima; Schaeffer, Anthony J.; Gearhart, John P.; Matthews, Ranjiv I.

doi:10.1016/j.jpurol.2011.09.007

Cited by 27 publications

(6 citation statements)

References 26 publications

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“…In a study in South Carolina (USA), STEC found an average age of bladder closure of 4.6 days, whereas MUSHTAQ in London (England) had an average age of 3 days with extremes of 1–152 days. [ 5 6 ] In our series, no patient was operated in the first 72 h of life due to delayed consultation or care.…”

Section: Discussionmentioning

confidence: 92%

Bladder Exstrophy

Agbara¹,

Moulot²,

Ehua³

et al. 2022

African Journal of Paediatric Surgery

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Introduction: Bladder exstrophy is a major malformation in paediatric urology. The treatment results are not still completely satisfactory, and their management is an enormous problem in Sub-Saharan Africa. While outlining our challenges, we report our management experience to improve our results. Subjects and Methods: We retrospectively reviewed the records of patients undergoing surgical repair of classic bladder exstrophy at our department between January 2010 and December 2019 (10 years). Epidemiological, clinical, therapeutic and evolution data were analysed. Results: Twenty-five children with classic bladder exstrophy were treated. Our series included 16 boys and 9 girls with a sex ratio of 1.7. Age ranged from 0 day to 6 years. Twenty-five bladder closures were performed, associated to pelvic osteotomy in 11 cases. Epispadias repair was performed on nine boys. Eight cases of bladder neck reconstruction and three cases of bladder enlargement were performed. We observed six bladder fistulas, four wound dehiscence, of which three partial, two parietal suppurations and six cases of urinary tract infection. Eight children had a continence of 1–2 h. Conclusion: The treatment of bladder exstrophy in our context is still limited because of financial difficulties encountered by the population and the insufficient technical platform in our country.

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Section: Discussionmentioning

confidence: 92%

Bladder Exstrophy

Agbara¹,

Moulot²,

Ehua³

et al. 2022

African Journal of Paediatric Surgery

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“…Nowadays, a straightforward management with a "detailed and regimented plan" is postulated in primary and delayed closure to prevent complications and additionally an increase in costs (15)(16)(17). Although not statistically significant, prospectively observed patients were operated on more often with the staged approach at an earlier age.…”

Section: Discussionmentioning

confidence: 99%

Treatment Strategies and Outcome of the Exstrophy–Epispadias Complex in Germany: Data From the German CURE-Net

et al. 2020

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Introduction: To evaluate the impact of reconstructive strategies and post-operative management on short-and long-term surgical outcome and complications of classical bladder exstrophy (CBE) patients' comprehensive data of the multicenter German-wide Network for Congenital Uro-Rectal malformations (CURE-Net) were analyzed.Methods: Descriptive analyses were performed between 34 prospectively collected CBE patients born since 2009, median 3 months old [interquartile range (IQR), 2-4 months], and 113 cross-sectional patients, median 12 years old (IQR, 6-21 years).Results: The majority of included individuals were males (67%). Sixty-eight percent of the prospectively observed and 53% of the cross-sectional patients were reconstructed using a staged approach (p = 0.17). Although prospectively observed patients were operated on at a younger age, the post-operative management did not significantly change in the years before and after 2009. Solely, in prospectively observed patients, peridural catheters were used significantly more often (p = 0.017). Blood transfusions were significantly more frequent in males (p = 0.002). Only half of all CBE individuals underwent inguinal hernia repair. Cross-sectional patients after single-stage reconstructions showed more direct post-operative complications such as upper urinary tract dilatations (p = 0.0021) or urinary tract infections (p = 0.023), but not more frequent renal function impairment compared to patients after the staged Ebert et al.Outcome of Exstrophy Reconstrution Techniques approach (p = 0.42). Continence outcomes were not significantly different between the concepts (p = 0.51). Self-reported continence data showed that the majority of the included CBE patients was intermittent or continuous incontinent. Furthermore, subsequent consecutive augmentations and catheterizable stomata did not significantly differ between the two operative approaches. Urinary diversions were only reported after the staged concept. Conclusions:In this German multicenter study, a trend toward the staged concept was observed. While single-stage approaches tended to have initially more complications such as renal dilatation or urinary tract infections, additional surgery such as augmentations and stomata appeared to be similar after staged and single-stage reconstructions in the long term.

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“…If the surgical repair is performed later, there is a higher risk of urinary incontinence or uterine prolapsed, infertility and increased risk of bladder adenocarcinoma [86]. Besides the bladder closure, pediatric surgeons must repair also the epispadias simultaneously, or in staged intervention, to offer an acceptable appearance and function of the external genitalia [98].…”

Section: Cloacal and Bladder Exstrophymentioning

confidence: 99%

Fetal Abdominal Wall Defects

Dragusin¹,

Şorop-Florea²,

LaurențiuPătru³

et al. 2018

Congenital Anomalies - From the Embryo to the Neonate

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Abdominal wall defects (AWDs) represent a group of congenital anomalies that can be diagnosed early during pregnancy even at the time of the first trimester assessment, with direct impact on pre-and postnatal fetal prognosis and management decisions. The most frequent anomalies in this group are gastroschisis and omphalocele. The key method available, that allows the detection of any deviation from the physiologic midgut herniation, is the ultrasound (US) assessment. A precise algorithmic scan approach is imposed not only for an accurate detection of any abdominal wall defect, but also for a proper location of the defect and of the spatial relation to the umbilical cord insertion, fundamentally important in differentiating among various malformations. Other structural or chromosomal anomalies should be excluded. Suitable multidisciplinary counseling should be considered. Unfortunately, in utero surgery, in these cases, has not been yet successful. Postnatal early interventions are usually required in specialized pediatric centers.

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The modern staged repair of classic bladder exstrophy: A detailed postoperative management strategy for primary bladder closure

Cited by 27 publications

References 26 publications

Bladder Exstrophy

Bladder Exstrophy

Treatment Strategies and Outcome of the Exstrophy–Epispadias Complex in Germany: Data From the German CURE-Net

Fetal Abdominal Wall Defects

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