Management of exstrophy/epispadias at the children's hospital of philadelphia

Abstract

Purpose Exstrophy/epispadias remains a significant surgical challenge with the goal being daytime and night time continence, volitional voiding, normal renal function and a cosmetically acceptable penis. The complete anatomic primary repair (CPRE) has been advocated as a technique to achieve these goals as first described by Mitchell. Material and methods To date, 18 patients who were born with classic bladder exstrophy or epispadias have undergone the CPRE since 1998. Age range now are from 6 mo to 10.6 years. Follow up has included routine ultrasonography, voiding cystourethrography or video urodynamic evaluation. Dry intervals assessed are those greater than 3 hours, 1-3 hours, persistently wet and those still in diapers but with dry intervals. Results Four patients are dry for greater than 3 hours with 2 achieving night time continence. Nine patients are dry for 1-3 hour intervals, three have persistent incontinence and two have dry intervals while in diapers but are under 2 years of age. Conclusions Surgical repair of bladder exstrophy/epispadias remains one of our consummate surgical challenges. We have adopted a consistent surgical approach and team to try to improve outcome. We believe that iliac osteotomies facilitate the closure even in the newborn and may improve epispadias repair. We feel that early repair is optimal (