World Journal of Urology

, Volume 24, Issue 3, pp 244–249 | Cite as

Standing the test of time: long-term outcome of reconstruction of the exstrophy bladder

  • C. R. J. Woodhouse
  • Amanda C. North
  • John P. Gearhart
Topic Paper

Abstract

The surgical management of classic bladder exstrophy has evolved over time. Different techniques are used to address the challenge of reconstructing these patients. We review the long-term outcomes of bladder exstrophy treatment from the published literature with regard to urinary continence, voiding and secondary complications. Continence now can be achieved in up to 80% of children in specialist centres. Whether such success can sustained into adult life is uncertain. About 40% of adults are dry in the best hands. Up to 84% of children can void, but there is some evidence that this function is lost with time in 70%. The need for bladder augmentation is widely variable between series, reported in 0–70% of children. This reduces the ability to void spontaneously to about 50% of children. It brings with it the later risk of metabolic disturbance and stone formation. Adults with exstrophy have a 694-fold increase in the risk of bladder cancer by the age of 40 years.

Keywords

Bladder exstrophy Urinary incontinence Follow-up 

References

  1. 1.
    Trendelenberg F (1906) The treatment of ectopia vesicae. Ann Surg 44:281–289CrossRefGoogle Scholar
  2. 2.
    Mayo CH, Hendricks WA (1926) Exstrophy of the bladder. Surg Gynecol Obstet 43:129–134Google Scholar
  3. 3.
    Cappolichio G, McClorie GA, Farhat W, Merguerian PA, Bagli DJ, Khoury AE (2001) A population based analysis of continence outcomes and bladder exstrophy. J Urol 165:2418–2421CrossRefPubMedGoogle Scholar
  4. 4.
    Lottmann HB, Melin Y, Cendron M, Lombrail P, Beze-Beyrie P, Cendron J (1997) Bladder exstrophy evaluation of factors leading to continence with spontaneous voiding after staged reconstruction. J Urol 158:1041–1044CrossRefPubMedGoogle Scholar
  5. 5.
    Mouriquand PD, Bubanj T, Feyaerts A, Jandric M, Timsit M, Mollard P et al (2003) Long-term results of bladder neck reconstruction for incontinence in children with classical bladder exstrophy or incontinent epispadias. Br J Urol Int 92:997–1002Google Scholar
  6. 6.
    Surer I, Baker LA, Jeffs RD, Gearhart JP (2001) Modified Young-Dees-Leadbetter bladder neck reconstruction in patients with successful primary bladder neck closure elsewhere: a single institution experience. J Urol 165:2438–2440CrossRefPubMedGoogle Scholar
  7. 7.
    Grady RW, Mitchell ME (1999) Complete primary repair of exstrophy. J Urol 162:1415–1420CrossRefPubMedGoogle Scholar
  8. 8.
    Hammouda HM, Kotb H (2004) Complete primary repair of bladder exstrophy: initial experience with 33 cases. J Urol 172:1441–1444CrossRefPubMedGoogle Scholar
  9. 9.
    Lattimer JK, Beck L, Yeaw S, Puchner PJ, Macfarlane MT, Krisiloff M (1978) Long term follow up after exstrophy closure late improvement and good quality of life. J Urol 119:664–666PubMedGoogle Scholar
  10. 10.
    Mathews R, Gosling JA, Gearhart JP (2004) Ultra structure of the bladder in classic exstrophy: correlation with development of continence. J Urol 172:1446–1449CrossRefPubMedGoogle Scholar
  11. 11.
    Borer JG, Gargollo PC, Kinnamon DD, Bauer SB, Khoshbin S, Hendren WH et al (2005) Bladder growth and development after complete primary repair of bladder exstrophy in the newborn with comparison to the staged approach. J Urol 174:1553–1558CrossRefPubMedGoogle Scholar
  12. 12.
    Woodhouse CRJ, Redgrave NG (1996) Late failure of the reconstructed exstrophy bladder. Br J Urol 77:590–592PubMedGoogle Scholar
  13. 13.
    Ben-Chaim J, Jeffs RD, Reiner WG, Gearhart JP (1996) The outcome of patients with classic exstrophy in adult life. J Urol 155:1251–1252CrossRefPubMedGoogle Scholar
  14. 14.
    Shaw MB, Rink RC, Kaefer M, Cain MP, Casale AJ (2004) Continence and classic bladder exstrophy treated with a staged repair. J Urol 172:1450–1453CrossRefPubMedGoogle Scholar
  15. 15.
    Gerharz EW, McDougal WS (2004) Metabolic and functional consequences of urinary diversion through intestinal segments. World J Urol 22(3):155–234CrossRefPubMedGoogle Scholar
  16. 16.
    Filmer RB, Bruce JR (1990) Malignancies in bladder augmentations and intestinal conduits. J Urol 143:671–678PubMedGoogle Scholar
  17. 17.
    Soergel TM, Cain MP, Misseri R, Gardner TA, Koch MO, Rink RC (2004) Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder. J Urol 172:1649–1652CrossRefPubMedGoogle Scholar
  18. 18.
    Schlegel PN, Gearhart JP (1989) Neuroanatomy of the pelvis in an infant with cloacal exstrophy a detailed micro dissection with histology. J Urol 141:583–585PubMedGoogle Scholar
  19. 19.
    Orsola A, Estrada CR, Nguyen HT, Retik AB, Freeman MR, Peters CA et al (2004) Growth and stretch response of human exstrophy bladder smooth muscle cells molecular evidence of normal intrinsic function. Br J Urol Int 95:144–148Google Scholar
  20. 20.
    Silver RI, Gros D-AC, Jeffs RD, Gearhart JP (1997) Urolithiasis in the exstrophy-epispadias complex. J Urol 158:1322–1326CrossRefPubMedGoogle Scholar
  21. 21.
    Barrosso U, Jednak R, Fleming P, Barthold JS, Gonzalez R (2000) Bladder calculi in children who perform clean intermittent catheterisation. Br J Urol Int 85:879–884Google Scholar
  22. 22.
    Woodhouse CRJ, Lennon GM (1998) Management and aetiology of stones in intestinal urinary reservoirs. Br J Urol 81(suppl 4):47Google Scholar
  23. 23.
    Wattenberg CA, Beare JB, Tormey AR (1956) Exstrophy of the urinary bladder complicated by adenocarcinoma. J Urol 75:583–593Google Scholar
  24. 24.
    Novak TE, Lakshmanan Y, Frimberger D, Epstein JI, Gearhart JP (2005) Polyps in the exstrophy bladder a cause for concern? J Urol 174:1522–1526CrossRefPubMedGoogle Scholar
  25. 25.
    Strachan JR, Woodhouse CRJ (1991) Malignancy following ureterosigmoidostomy in patients with exstrophy. Br J Surg 78:1216–1218PubMedCrossRefGoogle Scholar
  26. 26.
    Smeulders N, Woodhouse CRJ (2001) Neoplasia in adult exstrophy patients. Br J Urol Int 87:623–628Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • C. R. J. Woodhouse
    • 1
    • 2
  • Amanda C. North
    • 1
    • 2
  • John P. Gearhart
    • 1
    • 2
  1. 1.The Institute of UrologyUniversity College LondonLondonUK
  2. 2.Division of Paediatric Urology, James Buchanan Brady Urological InstituteThe Johns Hopkins HospitalBaltimoreUSA

Personalised recommendations