BLADDER EXSTROPHY - EVALUATION OF FACTORS LEADING TO CONTINENCE WITH SPONTANEOUS VOIDING AFTER STAGED RECONSTRUCTION

Purpose: We performed a long-term retrospective review of patients wit h bladder exstrophy to evaluate the results of staged surgical reconst ruction in regard to urinary continence, spontaneous voiding and prese rvation of the upper urinary tract. Materials and Methods: We reviewed the charts of 42 boys and 15 girls treated at Hopital St. Joseph for bladder exstrophy between 1965 and 1995. All patients underwent staged repair, including bladder augmentation in 7 (12%) and secondary urina ry diversion in 13 (23%). Criteria for good outcome in terms of contin ence are defined and factors influencing outcomes are reviewed. Result s: A total of 38 patients (67%) achieved good or acceptable urinary co ntinence (22 or 39% and 16 or 28%, respectively). Outcome was poor in 19 patients, including 13 (23%) who underwent secondary urinary divers ion. Bladder stones, which developed in 13 patients (23%), were the mo st common long-term complication of bladder exstrophy reconstruction, Ten patients who underwent pelvic osteotomies ultimately had better co ntinence and 9 are dry. Bladder neck reconstruction was performed at a later age overall (mean 10 years). Repeat bladder neck reconstruction was generally associated with poor results. The technique of bladder neck reconstruction did not appear to influence outcome, Conclusions: A carefully planned surgical reconstruction for bladder exstrophy can lead to satisfactory long-term urinary continence in most patients. Fa ctors contributing to successful results include early bladder closure , pelvic osteotomy, adequate bladder neck reconstruction with bladder neck suspension in girls, and a motivated child and family. Alternativ es to surgical reconstruction should be discussed. Ultimate predictors of outcome in bladder exstrophy repair are difficult to ascertain.