THE MULTIPLE REOPERATIVE BLADDER EXSTROPHY CLOSURE - WHAT AFFECTS THEPOTENTIAL OF THE BLADDER

Objectives. To define the possible cause of failure and the eventual p otential of the bladder in 23 exstrophy patients, who underwent more t han two failed prior attempts at closure. Methods. Twenty-three patien ts were selected from the exstrophy data base who had two or more prio r closures. Eighteen patients had undergone 2 previous closures and 5 patients 3 previous closures for either complete dehiscence or signifi cant prolapse, At the time of initial closure, 19 patients did not hav e an osteotomy. At secondary closure, 10 underwent osteotomy while at third closure 5 had an osteotomy. At the time of reclosure at our inst itution all underwent an osteotomy. Results. Reoperative repair at our institution was successful in all patients. Six patients achieved a b ladder size suitable for bladder neck reconstruction and of them 3 are dry. The bladder size was inadequate in 9 patients and 8 are being mo nitored for possible bladder growth. Conclusions. Tension-free closure with osteotomy and immobilization are important factors both in an in itial or any subsequent closure. The chance of obtaining an adequate b ladder capacity for bladder neck plasty and eventual continence, follo wing multiple reclosures, is markedly diminished.