Abstract
Patients with the exstrophy-epispadias complex are one of the most challenging groups encountered by pediatric urologists. They generally require surgery involving several reconstruction techniques, usually performed after the first week of life. Common problems in subsequent years include issues related to continence, sexual function, and the appearance of the lower abdomen and genitals. This article reviews major publications over the last few years related to managing patients with this rare, complex, congenital genitourinary anomaly.
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References and Recommended Reading
Wilson C, Christie D, Woodhouse CR: The ambitions of adolescents born with exstrophy: a structured survey. BJU Int 2004, 94:607–612.
Diseth TH, Emblem R, Schultz A: Mental health, psychosocial functioning, and quality of life in patients with bladder exstrophy and epispadias — an overview. World J Urol 1999, 17:239–248.
Lee C, Reutter HM, Grasser MF, et al.: Gender-associated differences in the psychosocial and developmental outcome in patients affected with the bladder exstrophy-epispadias complex. BJU Int 2006, 97:349–353.
VanderBrink BA, Stock JA, Hanna MK: Aesthetic aspects of bladder exstrophy: results of puboplasty. J Urol 2006, 176:1810–1815.
Cook AJ, Farhat WA, Cartwright LM, et al.: Simplified mons plasty: a new technique to improve cosmesis in females with the exstrophy-epispadias complex. J Urol 2005, 173:2117–2120.
Khoury AE, Papanikolaou F, Afshar K, Zuker R: A novel approach to skin coverage for epispadias repair. J Urol 2005, 173:1332–1333.
Pippi Salle JL, Jednak R, Capolicchio JP, et al.: A ventral rotational skin flap to improve cosmesis and avoid chordee recurrence in epispadias repair. BJU Int 2002, 90:918–923.
D’Hauwers KW, Feitz WF, Kremer JA: Bladder exstrophy and male fertility: pregnancies after ICSI with ejaculated or epididymal sperm. Fertil Steril 2007, In press.
Gargollo PC, Borer JG, Retik AB, et al.: Magnetic resonance imaging of pelvic musculoskeletal and genitourinary anatomy in patients before and after complete primary repair of bladder exstrophy. J Urol 2005, 174:1559–1566.
Stec AA, Pannu HK, Tadros YE, et al.: Pelvic floor anatomy in classic bladder exstrophy using 3-dimensional computerized tomography: initial insights. J Urol 2001, 166:1444–1449.
Muir TW, Aspera AM, Rackley RR, Walters MD: Recurrent pelvic organ prolapse in a woman with bladder exstrophy: a case report of surgical management and review of the literature. Int Urogynecol J Pelvic Floor Dysfunct 2004, 15:436–438.
McKenna PH, Khoury AE, McLorie GA, et al.: Iliac osteotomy: a model to compare the options in bladder and cloacal exstrophy reconstruction. J Urol 1994, 151:182–186.
Frey P, Cohen SJ: Anterior pelvic osteotomy. A new operative technique facilitating primary bladder exstrophy closure. Br J Urol 1989, 64:641–643.
Shultz WG: Plastic repair of exstrophy of bladder combined with bilateral osteotomy of ilia. J Urol 1958, 79:453–458.
Gearhart JP, Forschner DC, Jeffs RD, et al.: A combined vertical and horizontal pelvic osteotomy approach for primary and secondary repair of bladder exstrophy. J Urol 1996, 155:689–693.
Schmidt AH, Keenen TL, Tank ES, et al.: Pelvic osteotomy for bladder exstrophy. J Pediatr Orthop 1993, 13:214–219.
Chiari G, Avolio L, Bragheri R: Bilateral anterior pubic osteotomy in bladder exstrophy repair: report of increasing success. Pediatr Surg Int 2001, 17:160–163.
Satsuma S, Kobayashi D, Yoshiya S, Kurosaka M: Comparison of posterior and anterior pelvic osteotomy for bladder exstrophy complex. J Pediatr Orthop B 2006, 15:141–146.
Segev E, Ezra E, Binyamini Y, et al.: A combined vertical and horizontal pelvic osteotomy approach for repair of bladder exstrophy: the Dana experience. Isr Med Assoc J 2004, 6:749–752.
Kajbafzadeh AM, Tajik P: A novel technique for approximation of the symphysis pubis in bladder exstrophy without pelvic osteotomy. J Urol 2006, 175:692–697.
Mathews R, Gearhart JP, Bhatnagar R, Sponseller P: Staged pelvic closure of extreme pubic diastasis in the exstrophy-epispadias complex. J Urol 2006, 176:2196–2198.
Nelson CP, King J, Sponseller PD, Gearhart JP: Repeat pelvic osteotomy in patients with failed closure of bladder exstrophy: applications and outcomes. J Pediatr Surg 2006, 41:1109–1112.
Koff SA: A modest proposal to standardize the clinical evaluation of structural urinary incontinence in children. Dial Ped Urol 2006, 27:2–3.
DeCambre M, Casale P, Grady R, et al.: Modified bladder neck reconstruction in patients with incontinence after staged exstrophy/epispadias closures. J Urol 2006, 176:288–291.
Burki T, Hamid R, Ransley PG, et al.: Injectable polydimethylsiloxane for treating incontinence in children with the exstrophy-epispadias complex: long-term results. BJU Int 2006, 98:849–853.
Burki T, Hamid R, Duffy P, et al.: Long-term followup of patients after redo bladder neck reconstruction for bladder exstrophy complex. J Urol 2006, 176:1138–1141.
Shaw MB, Rink RC, Kaefer M, et al.: Continence and classic bladder exstrophy treated with staged repair. J Urol 2004, 172:1450–1453.
Baird A, Nelson, CP, Gearhart, JP: Modern staged repair of bladder exstrophy: a contemporary series. J Pediatr Urol 2007, 3:311–315.
Grady RW, Mitchell ME: Complete primary repair of exstrophy. J Urol 1999, 162:1415–1420.
Chan DY, Jeffs RD, Gearhart JP: Determinants of continence in the bladder exstrophy population: predictors of success? Urology 2001, 57:774–777.
Caione P, Capozza N, Zavaglia D, De Dominicis M: Anterior perineal reconstruction in exstrophy-epispadias complex. Eur Urol 2005, 47:872–877.
Novak TE, Lakshmanan Y, Frimberger D, et al.: Polyps in the exstrophic bladder. A cause for concern? J Urol 2005, 174:1522–1526.
Nielsen K, Nielsen KK: Adenocarcinoma in exstrophy of the bladder-the last case in Scandinavia? A case report and review of literature. J Urol 1983, 130:1180–1182.
Smeulders N, Woodhouse CR: Neoplasia in adult exstrophy patients. BJU Int 2001, 87:623–628.
Mathews R, Gosling JA, Gearhart JP: Ultrastructure of the bladder in classic exstrophy: correlation with development of continence. J Urol 2004, 172:1446–1449.
Sponseller PD, Bisson LJ, Gearhart JP, et al.: The anatomy of the pelvis in the exstrophy complex. J Bone Joint Surg Am 1995, 77:177–189.
Halachmi S, Farhat W, Konen O, et al.: Pelvic floor magnetic resonance imaging after neonatal single stage reconstruction in male patients with classic bladder exstrophy. J Urol 2003, 170:1505–1509.
Williams AM, Solaiyappan M, Pannu HK, et al.: 3-dimensional magnetic resonance imaging modeling of the pelvic floor musculature in classic bladder exstrophy before pelvic osteotomy. J Urol 2004, 172:1702–1705.
Alpert SA, Cheng EY, Kaplan WE, et al.: Bladder neck fistula after the complete primary repair of exstrophy: a multi-institutional experience. J Urol 2005, 174:1687–1689.
El-Sherbiny MT, Hafez AT: Complete repair of bladder exstrophy in boys: can hypospadias be avoided? Eur Urol 2005, 47:691–694.
Hafez AT, El-Sherbiny MT: Complete repair of bladder exstrophy: management of resultant hypospadias. J Urol 2005, 173:958–961.
Husmann DA, Gearhart JP: Loss of the penile glans and/or corpora following primary repair of bladder exstrophy using the complete penile disassembly technique. J Urol 2004, 172:1696–1700.
Canturk F, Tander B, Tander B, et al.: Bladder exstrophy: effects on bone age, bone mineral density, growth, and metabolism. Bone 2005, 36:69–73.
Hammouda HM, Kotb H: Complete primary repair of bladder exstrophy: initial experience with 33 cases. J Urol 2004, 172:1441–1444.
Borer JG, Gargollo PC, Hendren WH, et al.: Early outcome following complete primary repair of bladder exstrophy in the newborn. J Urol 2005, 174:1674–1678.
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Eeg, K.R., Khoury, A.E. The exstrophy-epispadias complex. Curr Urol Rep 9, 158–164 (2008). https://doi.org/10.1007/s11934-008-0028-x
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DOI: https://doi.org/10.1007/s11934-008-0028-x