TECHNIQUES TO CREATE CONTINENCE IN THE FAILED BLADDER EXSTROPHY CLOSURE PATIENT

We reviewed retrospectively 315 patients with bladder exstrophy treate d at our hospital between July 1976 and April 1992 to assess the outco me of those who failed primary closure of the bladder. Of the patients 47 required reclosure of the bladder, including 28 who have undergone a procedure to restore urinary continence. Methods used to achieve dr yness included bladder neck reconstruction in 18 patients, bladder nec k reconstruction along with augmentation in 4, augmentation alone in 4 , repeat bladder neck reconstruction in 1, and reclosure with creation of a continent stoma and augmentation in 1. Nine of 18 patients who u nderwent primary bladder neck reconstruction are dry on intermittent c atheterization, while 8 of the remaining 9 are dry and voiding without catheterization. Four patients who underwent primary bladder neck rec onstruction and augmentation, and 4 who underwent augmentation after b ladder neck reconstruction are dry on intermittent catheterization. Th e patient who underwent reclosure, bladder augmentation and creation o f a continent abdominal stoma is dry on intermittent catheterization. Virtually all patients who failed the initial closure and later bladde r neck reconstruction for continence require augmentation and intermit tent catheterization to remain dry. Of 28 patients who underwent salva ge procedures only 1 had upper tract changes. With attention to detail and the use of a variety of reconstructive techniques children who ha ve failed exstrophy closure can achieve continence and have stable ren al function.