Continent cutaneous diversion for bladder exstrophy in adults

Abstract

ObjectivesBladder exstrophy is a rare and devastating congenital anomaly. These patients are usually seen immediately after birth where correction can be attempted. Presentation in adulthood where bony fusion has occurred and bladder capacity is very low presents a major surgical challenge. Such patients require urinary diversion. This is a review of our initial experience with continent cutaneous urinary diversion in patient with classic bladder exstrophy who presented in adulthood. Patients and methodsWe reviewed the social and clinical characteristics, operative reports, and postoperative course of two female and five male patients who have been living with bladder exstrophy since birth. They underwent augmentation cystoplasty or simple cystectomy, bladder neck transection, repair of epispadias followed by a continent cutaneous diversion. The continent catheterizable outlet was constructed using the serous lined extramural tunnel technique as a continence mechanism. Postoperative continence, renal function, and changes in social life were documented. ResultsFollow-up has ranged from 17 months to 5 years in these initial patients. Thus far, all these patients have achieved complete daytime and night time continence, Complications consisted of pouch cutaneous fistula which was successfully repaired with interposition of a rectus abdominis flap and one case of urosepsis. All upper urinary tract imaging studies have shown stable function. All the patients are doing well with improved social interaction. ConclusionBladder neck closure in conjunction with continent cutaneous diversion is a reliable and safe method for achieving continence in adults presenting with bladder exstrophy. Total continence can be achieved without resorting to multiple complex and expensive surgeries.