NEWBORN EXSTROPHY CLOSURE AND EPISPADIAS REPAIR

Over the last 150 years bladder exstrophy has undergone a transition f rom a primarily nonsurgically treated disease to a disease treated by urinary diversion or staged repair and non;, possibly. primary newborn reconstruction. Our enthusiasm ior primary reconstruction arises beca use of its potential to simplify the management of this disorder and o ptimize the return of normal bladder function for these patients, As w ith most neu concepts. the evolution of our primary reconstruction tec hniques could not have been achieved without the prior efforts of othe rs, Other surgeons such as H. HI. Young and J. Ansell have shown us th e possibility of achieving urinary continence with primary newborn exs trophy closure without sacrificing renal function, but the results hav e been inconsistent in the past. Staged reconstruction for bladder exs trophy demonstrates the possibility to achieve consistent successful r ates of continence in these patients, However. multiple surgical proce dures are required to attain this success. The preliminary results of our series of primary bladder ess trophy closures has encouraged us to perform it for all neonates referred to our institution with bladder exstrophy as well as to use it as part of staged reconstructive: effor ts for patients who have undergone primary surgical procedures for exs trophy elsewhere, We are hopeful and optimistic that newborn primary e xstrophy closure performed as described herein will produce consistent rates of urinary continence and allow normal voiding function as well .