VESICAL NECK RECONSTRUCTION IN PATIENTS WITH THE EXSTROPHY-EPISPADIASCOMPLEX

Purpose: We evaluated the factors critical in achieving urinary contin ence in patients with the exstrophy-epispadias complex. Materials and Methods: A total of 51 patients with epispadias and 33 with classic bl adder exstrophy underwent vesical neck reconstruction. Patient records were reviewed to identify factors associated with the achievement of continence, including timing of bladder closure and urethroplasty, eff ect of bladder capacity before and after vesical neck reconstruction, and effect of enterocystoplasty. Results: Complete urinary continence was achieved in 42 of the 51 patients with epispadias (82%) and in 23 of the 33 with exstrophy (70%). Delayed bladder closure did not affect the ability to gain continence but increased the likelihood of subseq uent enterocystoplasty (12 of 19 patients, 63%) compared to early blad der closure (5 of 14 patients, 36%). Conclusions: Preliminary urethrop lasty did not enhance urinary control or reduce the need for enterocys toplasty. Bladder capacity before vesical neck reconstruction did not predict the need for enterocystoplasty or ultimate continence status i n individuals. Adequate bladder capacity after vesical neck reconstruc tion was an important determinant of urinary continence. Approximately half of the patients with bladder exstrophy (17 of 33) required augme ntation cystoplasty to achieve urinary continence.