Urinary continence after reconstruction of classical bladder exstrophy (73 cases)

Abstract

The outcome of bladder neck reconstruction was unpredictable. Achievement of a balance between intravesical pressure and outlet resistance was difficult and often required secondary endourethral procedures. Persistent incontinence after bladder neck reconstruction was related to insufficient outlet resistance, an abnormal bladder or a combination of the two. Repeated bladder neck reconstruction, bladder augmentation, bladder neck suspension and reconstruction combined with augmentation were performed. These operations were coupled with a Mitrofanoff procedure, which offered catheterization as a safe alternative if further complications occurred.

Current management of bladder exstrophy

“…Gender was the strongest predictor of continence in this series and ultimately was achieved in 94% of females and 69% of males after BNR alone, BNR with augmentation cystoplasty, or bladder neck closure. Mollard et al [22] reported continence with urethral voiding in 69% of 54 patients at the 1-to 17-year follow-up after BNR, with the authors' technique being performed for most patients.…”

Endoscopic Treatment of Urinary Incontinence in Children With Primary Epispadias

“…The Young-Dees-Leadbetter bladder neck reconstruction is the established method to create increased bladder outlet resistance in the exstrophy/epispadias complex [2,3]. However, the procedure and its modifications [6,10,11] require the use of some of the base of the bladder, which may have a limited capacity. Hollowell et al suggested that the normal bladder usually associated with primary epispadias may be disturbed by this major reconstructive procedure [12].…”

“…collagen, Teflon or polydimethylsiloxane particles (MacroplastiqueTM, Uroplasty Inc), material the needle was lubricated with EZ gelTM (Uroplasty Inc). (MPQ) [6][7][8]. The endoscopic suburothelial insertion of material into the posterior urethral region represents a minimally invasive technique which is less likely to interfere with bladder wall structure and function.…”

Primary closure of the Urinary Bladder, Urethra and Anterior Abdomen of Classical and Cloacal 39 Exstrophy - A Preliminary Experience of Three Consecutive Cases

“…Second male patient might achieve acceptable continence after epispadias repair and bladder neck reconstruction, which was also suggested by Baird et al 4 . In another series, long-term follow-up for urinary continence after reconstruction of classical bladder exstrophy indicated unpredictable outcome 2,5 .…”