Bladder preservation in adult classic exstrophy: Early results of four patients

Objectives. To report our experience with the treatment of classic exstroph y of the bladder in a small series of adult patients using ileocystoplasty, bladder neck reconstruction, and abdominal wall closure with flaps. The pr esentation of exstrophy of the bladder in adulthood is rare. The problems e ncountered include difficulty in abdominal closure, malignant potential, an d upper tract dysfunction, The treatment of choice has been cystectomy with urinary diversion in all reported cases. Methods. We treated 4 adult male patients with classic exstrophy of the bla dder and complete epispadias, They had not received any previous treatment. Multiple random bladder biopsies revealed nonspecific inflammatory changes with focal areas of keratinization. Three patients were treated in two sta ges, The first stage included ileocystoplasty, bladder neck reconstruction, and abdominal wall closure with the use of flaps. The epispadias was repai red in the second stage. In 1 patient, the reconstruction was completed in a single stage. Results, All patients were continent at the last follow-up visit, with thre e using self-catheterization and one voiding spontaneously. The renal param eters and ultrasound scans were normal at a follow-up of 2 to 48 months. Cy stoscopy performed at 6 months postoperatively revealed normal-looking muco sa in 2 patients and mild inflammation in 1 patient. Three patients were sa tisfied with the cosmetic results and one complained of the small size of h is penis, All patients were evaluated by psychiatrists and revealed anxiety disorders preoperatively. After surgery, all demonstrated improved social interaction, Conclusions, Vesical preservation with primary reconstruction of bladder ex strophy in adults is safe and feasible in the absence of significant histol ogic changes in the bladder mucosa. Abdominal closure can be achieved witho ut difficulty with the use of transposition flaps. However, these patients require strict follow-up to detect malignant transformation at an early sta ge, UROLOGY 57: 906-910, 2001. (C) 2001, Elsevier Science Inc.