Staged functional closure of bladder extrophy (author's transl)

Abstract

Two surgical alternatives exist in the treatment of classic bladder exstrophy: urinary diversion and functional closure. The staged ureterosigmoidostomy is the treatment of choice for patients not suitable for bladder and urethral reconstruction. The treatment of the patients selected for closure begins by closing the bladder during the neonatal period. Osteotomy appears to be necessary in children older than 2 days. Incontinence and vesico-ureteral reflux are treated by bladder neck-urethral reconstruction and reimplantation of the ureters at three years of age. Closure of the epispadias follows in the fifth year. It may be necessary to treat upper tract complications by secondary urinary diversion. Concerning incontinence, technical improvement in artificial sphincter may soon offer an alternative to urinary diversion. The results of 70 primary bladder closures selected from 94 patients presenting with bladder exstrophy are presented: 54 patients with long-term follow-up and completed staged repair were available for assessment: 31 (57.5%) proved to have a good result and 10 (18.5%) to have a fair results. 13 (24.0%) were completely incontinent or required diversion. Failures were thought to be the results of inadequate selection or failure to achieve continence.