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Single-staged male bladder exstrophy–epispadias complex reconstruction with pubic bone adaptation without osteotomy: 15-year single-center experience

  • Urology - Original Paper
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Abstract

Purpose

To represent the 15 years’ experience of an academic referral center for the reconstruction of bladder exstrophy–epispadias complex with a modified single-stage approach. Single-staged reconstruction techniques are commonly used for classic bladder exstrophy. However, combined bladder closure and epispadias repair have been taken into great consideration in patients with initially failed reconstruction or delayed primary closure.

Methods

A total of 49 boys underwent 1-stage bladder and epispadias repair with pubic bone adaptation and without the application of pelvic osteotomy. The mean ± SD age at surgery was 5.23 ± 2.04 months. Continence and social dryness were assessed in the follow-ups with 3 months intervals for the first year and biannually thereafter.

Results

The mean ± SD of follow-up was 127.25 ± 71.32 months. Urethrocutaneous fistula, stricture, wound infection, and hemiglans were developed in six distinct patients. However, no other major complications were noted. Three patients (6.1%) remained incontinent; while 32 (65.3%) children were socially continent and 14 (28.6%) children were waiting for toilet training. All the patients without previous failed closure were socially continent, while all incontinent patients had two failed closures in their history. No patient was rendered hypospadiac.

Conclusion

Based on the experience of this institution, the application of single-stage reconstructive techniques can lead to continence, cosmetically pleasing appearance with promising outcomes, and reduction of overall operations, hospital stay and costs in the majority of cases as compared to multiple surgical procedures.

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Abbreviations

BEEC:

Bladder exstrophy–epispadias complex

BNR:

Bladder neck reconstruction

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Acknowledgements

Thank you to Seyedeh Sima Daryabari for her assistance with the collection of the data.

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None.

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Authors and Affiliations

  1. Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran

    Shabnam Sabetkish, Nastaran Sabetkish, Sahar Eftekharzadeh & Abdol-Mohammad Kajbafzadeh

  2. Pediatric Urology Research Center, Children’s Medical Center, Pediatric Center of Excellence, No. 62, Dr. Qarib’s St, Keshavarz Blvd, 1419433151, Tehran, Iran

    Abdol-Mohammad Kajbafzadeh

Authors
  1. Shabnam Sabetkish
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  2. Nastaran Sabetkish
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  3. Sahar Eftekharzadeh
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  4. Abdol-Mohammad Kajbafzadeh
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Contributions

AMK: protocol/project development. SS, SE: data collection or management. NS: data analysis. AMK, SS: manuscript writing/final editing.

Corresponding author

Correspondence to Abdol-Mohammad Kajbafzadeh.

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Informed consent was obtained from all individual participants included in the study.

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Sabetkish, S., Sabetkish, N., Eftekharzadeh, S. et al. Single-staged male bladder exstrophy–epispadias complex reconstruction with pubic bone adaptation without osteotomy: 15-year single-center experience. Int Urol Nephrol 53, 191–198 (2021). https://doi.org/10.1007/s11255-020-02648-y

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