Editorial Comment

Abstract

The authors reported the results of delayed primary closure for a select group of 20 children born with bladder exstrophy who had small inelastic or polypoidal bladders, with emphasis on their immediate postoperative management. Their multidisciplinary team included highly skilled pediatric urologists, pediatric orthopedic surgeons, and experienced nursing staff. Postoperatively, they treated the children parenteral nutrition, antibiotics, anticholinergics, and pain management. Successful closure was achieved in all 20 cases. These results make a compelling case for referral of difficult cases to centers of excellence. In a previous report in 2001 on 19 children, the authors achieved continence without the necessity for bladder augmentation or replacement in 47% of the cases (reference 6). Delayed Primary Closure of Bladder Exstrophy: Immediate Postoperative Management Leading to Successful OutcomesUrologyVol. 79Issue 2PreviewTo present the critical features of our postoperative plan for children undergoing delayed primary bladder closure because appropriate postoperative management is crucial to successful exstrophy repair. Full-Text PDF ReplyUrologyVol. 79Issue 2PreviewThe surgical management of the exstrophied bladder continues to evolve. Identifying the complexities associated with the management of infants with very small bladders that are deemed unsuitable for initial closure was the focus of this paper. At our institution, the focus of closure of the bladder and abdominal wall has always been directed toward achieving the best potential for voided continence. With this in mind, delaying closure to permit the bladder plate to increase in size has been a successful formula for our patients. Full-Text PDF