Urinary continence after staged bladder reconstruction for cloacal exstrophy: The effect of coexisting neurological abnormalities on urinary continence

Purpose: We determined whether there is a difference in the incidence of ur inary continence in cloacal and classic bladder exstrophy after staged blad der neck reconstruction using the Young-Dees-Leadbetter technique. Materials and Methods: We reviewed the records of patients with cloacal and classic bladder exstrophy who underwent staged bladder neck reconstruction from 1971 to 1997. Results: The Young-Dees-Leadbetter bladder neck reconstruction was complete d in 23 patients with cloacal exstrophy, of whom 5 (22%) became continent a nd 18 (78%) have persistent incontinence, A clinically apparent neurologica l abnormality significantly hindered the achievement of continence. Specifi cally 1 of the 13 children (7%) with versus 4 of the 10 (40%) without a neu rological abnormality became continent (p <0.05). In contrast, staged recon struction of classic bladder exstrophy resulted in urinary continence in 67 of the 82 patients (82%). Of the 67 continent patients 23 (34%) cannot voi d and require intermittent catheterization. None of the patients with class ic exstrophy had a neurological deficit. Conclusions: The ability of the Young-Dees-Leadbetter bladder neck reconstr uction to result in urinary continence significantly differs in the cloacal and classic bladder exstrophy populations (22 versus 82%, p <0.001). Our f indings also suggest that a coexisting neurological abnormality significant ly hinders the ability to reconstruct a functional bladder in patients with cloacal exstrophy.