Normal urodynamics in patients with bladder exstrophy: Are they achievable?

Purpose: Urodynamic study was performed in patients with exstrophy to deter mine the effect of bladder neck reconstruction and the ability to achieve n ormal urodynamics following surgery. Materials and Methods: A total of 30 exstrophy cases at different stages of reconstruction were retrospectively reviewed in terms of bladder capacity, compliance, stability and presence of detrusor contractions following urod ynamic study. Results: Bladder capacity increased from a third predicted volume for age t o half after reconstruction. Approximately 80% of patients had compliant an d stable bladders before bladder neck reconstruction. Following bladder nec k reconstruction approximately half of the patients maintained normal compl iance with a smaller number maintaining normal stability. A quarter of pati ents maintained normal filling dynamics following bladder neck reconstructi on, and 19% maintained normal filling and voiding dynamics after reconstruc tion. Conclusions: The majority of closed exstrophy bladders have normal filling dynamics before bladder neck reconstruction. Compliance and stability are i mpaired following bladder neck reconstruction. Approximately 25% of patient s with exstrophy may maintain normal detrusor function following reconstruc tion. However, less invasive alternatives to the Young-Dees-Leadbetter blad der neck reconstruction should be sought.