Modern staged reconstruction of bladder exstrophy—still the gold standard

Abstract

Early efforts at the management of bladder exstrophy were dogged by high morbidity and complications leading to poor long-term outcomes for continence and renal function. 1 Martinez-Pineiro J.A. Long-term results of surgical treatment of bladder exstrophy. Eur Urol. 1976; 2: 168-174 PubMed Google Scholar The staged reconstruction of bladder exstrophy was proposed by Jeffs 2 Jeffs R.D. Functional closure of bladder exstrophy. Birth Defects Orig Artic Ser. 1977; 13: 171-173 PubMed Google Scholar and led to significant improvements in continence and renal function with excellent cosmetic results. 3 Jeffs R.D. Exstrophy and cloacal exstrophy. Urol Clin North Am. 1978; 5: 127-140 PubMed Google Scholar Once universal survival was ensured, the paradigm for management shifted to additional reduction in complications and improvement in voiding continence. The initial staged management consisted of newborn bladder and posterior urethral closure followed by bladder neck reconstruction at 2 to 3 years of age and later epispadias repair. 3 Jeffs R.D. Exstrophy and cloacal exstrophy. Urol Clin North Am. 1978; 5: 127-140 PubMed Google Scholar The understanding that appropriately timed epispadias repair may lead to enhancement in bladder capacity led to performance of epispadias repair at 2 to 3 years of age followed by later bladder neck reconstruction. The current modification of the staged repair consists of secure bladder and posterior urethral closure in infancy followed by epispadias repair at 6 to 12 months of age and bladder neck reconstruction when the patient is able to cooperate in a good voiding program. 4 Chan D.Y. Jeffs R.D. Gearhart J.P. Determinants of continence in the bladder exstrophy population predictors of success?. Urology. 2001; 57: 774-777 Abstract Full Text Full Text PDF PubMed Google Scholar