Bladder Exstrophy Closure without Osteotomy in Philadelphia
To evaluate the complications following initial bladder closure and urinary continence in patients born with bladder exstrophy closed early without posterior iliac osteotomy.
Materials and Methods
A retrospective review of 105 patients treated at The Children’s Hospital of Philadelphia (CHOP) since 1952. Sixty-two patients had initial treatment at CHOP. Age at initial closure, surgical procedure and complications were noted. Follow up was performed with detailed questions regarding continence. Patients completing reconstructive surgery for continence were grouped as follows: Dryness was recorded as dry day and night, dry day only, dry three hours or wet. Continent patients were those patients who had achieved at least a 3-hour dry interval without the need for intermittent catheterization. Statistical analysis was performed using Fisher’s exact test.
Of 62 patients who had initial therapy at CHOP, 12 had initial ureterosigmoidostomy. Initial bladder closure was performed at CHOP for the remaining 50. Of the 50, 45 had both the closure and subsequent continence procedures at CHOP. Thirty-one of 43 (71%) of patients closed without osteotomy had a successful closure. Three of 5 closed with osteotomy were successful. Only 6 (13%) of the 45 patients are voiding through the native bladder with continence. Thirty (67%) of 45 are dry with intermittent catheterization. Neither age at initial closure, use of posterior iliac osteotomy nor use of paraexstrophy flaps (PEF) affected continence or complication rates of the initial bladder closure. Of only 5 patients closed with osteotomy, 2 are continent and voiding with the native bladder compared to only 4 of 20 patients closed without osteotomy (p=0.065).
Continence following staged reconstruction for bladder exstrophy is difficult to achieve even at a center with considerable experience. Most patients can be dry with intermittent catheterization or early closure of the bladder without osteotomy is not associated with increased risk of complications compared with closure with osteotomy. Despite few patients in this series, a trend toward improved continence in patients undergoing osteotomy was observed.
KeywordsBladder Neck Bladder Outlet Obstruction Intermittent Catheterization Urinary Continence Bladder Exstrophy
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