Bladder Exstrophy Combined with a Small Bladder Plate: Indication for Cystectomy or Primary Closure?

Abstract

Purpose Specialists debate whether it is reasonable or not to preserve a bladder exstrophy plate with a minimum size of less than 25 – 30 mm. Many urologists recommend that cystectomy be performed and the ureters be diverted from the bladder to an isolated segment of bowel. Is it possible to preserve bladder function in patients with minimum bladder sizes? Material and Methods Over a period of 1996-2008, 60 children from two days to eight months of age underwent surgical repair of bladder exstrophy. Group 1 included 42 (60%) children with a satisfactory size (>30 mm) of bladder plate, and group 2 included 18 (30%) with a small size ( Results The outcomes of primary closure were analyzed with regard to detrusor volume and dry periods. In the children under one year of age, the volume of the bladder was 30-70 ml in group 1 and 20-40 mm in group 2. However, 12 children from group 2 voided small portions of urine with dry periods of up to 10-15 min. At the age 1-3 years old, the children from group 2, with small bladder plates, underwent Cantwell-Ransley repair combined with grafting dorsal surface of corporeal bodies with endoscopic VUR correction (STING) as the second step of treatment. Finally, the bladder volume in the children from group 2 increased up to 50-60 ml, with dry periods of up to 30-40 min. At the next step of treatment, six patients from group 2 underwent uretrocystoneoctomy and bladder neck plasty. As a result, in the children of 1-3 years old, with small bladder plates, the bladder volume was 70-120 ml and dry periods were 40-70 min. Conclusions Our findings evidence that, even with small bladder plates, it is possible to achieve satisfactory outcomes of treatment of bladder exstrophy