Editorial Comment

Abstract

The management of bladder exstrophy continues to be a surgical challenge, and consistent surgical results are difficult to obtain unless reconstruction is performed at defined Centers of Excellence. The development of voided continence in children with exstrophy requires a secure initial closure of the bladder, with the posterior urethra and bladder neck placed deep in the pelvis, and then development of an adequate bladder capacity for eventual bladder neck reconstruction. Multiple factors can affect the ability of the bladder to achieve this critical capacity, including failure of the initial closure, 1 Gearhart J.P. Ben-Chaim J. Sciortino C. et al. The multiple reoperative bladder exstrophy closure: what affects the potential of the bladder?. Urology. 1996; 47: 240-243 Abstract Full Text PDF PubMed Scopus (82) Google Scholar obstruction of the outlet, 2 Baker L.A. Jeffs R.D. Gearhart J.P. Urethral obstruction after primary exstrophy closure: what is the fate of the genitourinary tract?. J Urol. 1999; 161: 618-621 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar recurrent urinary tract infections, and an inability of the bladder template to grow because of poor inherent characteristics. 3 Mathews R. Gosling J.A. Gearhart J.P. Ultrastructure of the bladder in classic exstrophy: correlation with development of continence. J Urol. 2004; 172: 1446-1449 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Evaluation of Need for Salvage Continence Procedures After Failed Modern Staged RepairUrologyVol. 76Issue 1PreviewTo assess our experience with salvage continence procedures in patients with bladder exstrophy. Full-Text PDF ReplyUrologyVol. 76Issue 1PreviewWe agree that because these children were referred from outside hospitals, it would be difficult to determine exactly what factors affected the bladder capacity and ultimate outcomes. New studies and evaluations were performed on their arrival at our center to direct our management. The aim of this study was to demonstrate that when patients were appropriately selected (ie, bladder capacity >85 mL), continence was ultimately achieved in most of the children with difficult and iatrogenically diverse features seeking treatment and improved quality of life. Full-Text PDF