Complete primary repair of exstrophy

Purpose: The surgical correction of bladder exstrophy to achieve continence with voiding remains a challenging problem for the urologist. Since 1989 w e have performed complete primary repair for exstrophy based on the concept that the primary defect of bladder and cloacal exstrophy is anterior herni ation. Thus, the bladder and urethra must be treated as a single unit to mo ve them posteriorly into the pelvis. We present this technique. Materials and Methods: From 1989 to 1997, 18 patients with bladder exstroph y and 6 with cloacal exstrophy underwent complete primary repair of exstrop hy. This procedure was done on day 1 of life in 18 patients. Mean followup is 44 months (range 4 months to 8 years). Results: At a median followup of 48 months 4 boys and 4 girls have volition al voiding after complete primary repair of bladder exstrophy, 21 patients have continent intervals and 2 boys void with continent intervals after com plete primary repair of cloacal exstrophy. No patient has had a loss of ren al function in this series. Postoperative complications included urethrocut aneous fistula formation in 2 cases. No patient had primary closure dehisce nce. Conclusions: The rate of urinary continence achieved with complete primary repair compares favorably to that of staged repair for exstrophy. Complete primary repair also minimizes the number of surgical procedures required to achieve urinary continence and potentiates bladder neck function that perm its bladder cycling in year 1 of life. The complication rates of these tech niques are significantly lower than those reported in previous series of pr imary closure of exstrophy.