Bladder Reconstruction in Exstrophy

Abstract

Between 1968 and 1978, 35 patients with complete exstrophy of the bladder have been treated. In 31 cases reconstruction was attempted using a 3-step procedure. First, the bladder was closed with a posterior iliac osteotomy and in the male patient the penis was lengthened. Next, an antireflux procedure and bladder neck reconstruction were done. The modification of the Young-Dees procedure was used, which allowed reconstruction of the vesicourethral angle as well as creation of an anterior muscular loop. Finally, the anterior epispadias was repaired. Of 16 patients who completed surgical treatment more than 1 year ago 6 female and 5 male subjects are cured, that is continent with a normal excretory urogram and no reflux. One male patient is improving and 4 boys are failures. The operative technique, postoperative training, results and selection of patients for functional closure are discussed.