World Journal of Urology

, Volume 16, Issue 3, pp 205–211

The staged approach to bladder exstrophy closure and the role of osteotomies

  • L. A. Baker
  • J. P. Gearhart

DOI: 10.1007/s003450050054

Cite this article as:
Baker, L. & Gearhart, J. World J Urol (1998) 16: 205. doi:10.1007/s003450050054


Since the 1970's, the staged reconstruction of bladder exstrophy has yielded consistent surgical success. The Johns Hopkins Hospital approach begins with early pelvic ring approximation with abdominal wall, bladder, and posterior urethral closure. Within the first 72 hours of life, the malleable pelvis can sometimes be approximated without osteotomies. Beyond this age, the author's prefer a combined vertical iliac and horizontal innominate osteotomy. Second, we typically perform the epispadias closure at 1 year of age. A modified Cantwell-Ransley technique is performed, usually yielding an increase in bladder capacity and very satisfactory results. In the last phase, the modified Young-Dees-Leadbetter continence procedure along with transtrigonal/cephalotrigonal ureteroneocystostomies are performed when the urethra is catheterizable, the bladder capacity is 60cc or greater, and the child will participate in a postoperative voiding program (typically 4–5 years of age). This applied approach usually results in a continent, voiding patient with pleasing external genitalia and preserved renal function.

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • L. A. Baker
    • 1
  • J. P. Gearhart
    • 1
  1. 1.Brady Urological Institute, Marburg 1, 600 N. Wolfe St., Johns Hopkins Hospital, Baltimore, MD 21287, USATP

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