Does Bilateral Ureteral Reimplantation at the Time of Primary Bladder Exstrophy Closure (CPRE-BUR) Protect the Upper Tracts?

Abstract

Purpose Recurrent febrile urinary tract infections (UTI) have been reported following complete primary repair of bladder exstrophy (CPRE), probably due to the association of vesico-ureteral reflux (VUR) and increased outlet resistance provided by CPRE. We compared outcomes of children who underwent CPRE-BUR to CPRE alone. Material and Methods CPRE-BUR was performed using a cephalo-trigonal technique in 13 pts with favorable bladder (smooth/elastic plate, group I) and compared to 23 pts who had CPRE alone (group II). Post-op assessment included ultrasound and voiding cystogram in all pts. Outcome measurements included: post-op hydronephrosis, febrile UTIs and presence of VUR. Results Mean follow-up was 21 m (6-42) and 58 m (11-105) for groups I and II, respectively. Median age at surgery was 3 days for both, ranging from 1 to 140 days. There were 9 boys and 4 girls in group I and 10 boys and 13 girls in group II. Outcomes are shown in the table below. There were no complications related to reimplantation. Variables CPRE-BUR CPRE n = 13 (%) n = 23(%) p value Post-op hydronephrosis 2 (15) ∗ 10 (43) 0.28 Post-op febrile UTIs 1 (8) ∗∗ 11 (48) 0.07 Vesico-ureteral reflux 0 (0) 17 (74) 0.004 ∗ Mild post-op hydronephrosis, resolved spontaneously. ∗∗ Febrile UTI after voiding cystogram. Conclusions CPRE-BUR can be safely performed in newborns with bladder exstrophy. It may prevent renal damage by early correction of VUR, and appears to reduce subsequent recurrent febrile UTIs.