Combined bladder neck reconstruction and epispadias repair for exstrophy-epispadias complex

Purpose: The achievement of satisfactory continence in the management of cl assic bladder exstrophy remains a surgical challenge. During the last 20 ye ars a staged approach to the management of the exstrophy-epispadias complex has been used at many exstrophy centers to attain this goal. In select cas es repairs can be combined to reduce the number of mandatory operations to achieve continence. We retrospectively review our experience with, and long -term results and complications of combined bladder neck reconstruction and epispadias repair. Materials and Methods: A total of 19 boys with classic bladder exstrophy (1 7) and complete male epispadias (2) underwent combined bladder neck reconst ruction and epispadias repair between 1982 and 1999. Primary closure was pe rformed elsewhere in 16 cases and osteotomy was performed at primary closur e in 8 (42%). All patients have undergone modified Cantwell-Ransley epispad ias repair except for 2 who underwent a Young procedure. Results: At the time of combined bladder neck and epispadias repair mean pa tient age was 5.2 years (range 2.5 to 10). Mean bladder capacity was 119 ml . (range 60 to 250). Of the 19 patients 13 (69%) are completely continent, and 2 (11%) are partially continent and 1 remained incontinent. Three patie nts did not gain satisfactory functional bladder capacity after combined re pair, and underwent bladder augmentation and a continent diversion procedur es. Conclusions: Combined bladder neck and epispadias repair is applicable in e xperienced hands but careful patient selection and long-term followup are t he most important issues to develop criteria to select those best to underg o this procedure.