Pediatric urologyDeterminants of continence in the bladder exstrophy population: predictors of success?
Section snippets
Material and methods
We reviewed records of 90 patients who underwent their initial bladder exstrophy reconstruction at our institution between 1975 and 1997. Our approach to the staged reconstruction of bladder exstrophy has been previously described.3 In general, bladder and posterior urethral closure with or without pelvic osteotomy are performed soon after birth or as soon thereafter as possible. Currently, in male patients, epispadias repair is performed at 6 months to 1 year of age after testosterone
Results
Of the 65 patients, 49 were boys and 16 were girls. The median and mean ages for primary closure were 9 days and 4 months, respectively. The average age of BNR was 4 years with a median capacity of 85 cc and mean of 93 cc. Of these 65 patients, 50 (77%) are continent day and night and voiding from the urethra without need for augmentation or clean intermittent catheterization. Nine (14%) patients have social continence, and are dry for more than 3 hours during the day but still wet at night.
Comment
Although the results are not statistically significant, closer analysis of the patients in the incontinent group may offer additional insight into gaining continence in the exstrophy population. Of the patients who performed poorly after BNR, 4 patients had a capacity of less than 85 cc at the time of bladder neck repair. In these patients, urodynamic evaluation after surgery revealed adequate outlet resistance, but simply a small capacity bladder without unstable contractions. The relative
Conclusions
Determinants of continence in the bladder exstrophy population are multifactorial. In our experience, 77% are all completely dry, day and night, and 91% can obtain social continence, being dry for at least 3 hours. In our study, because of the small number of patients in the study groups, statistical significance was not reached. However, the relative risk of failure is higher in the smaller bladder capacity group for augmentation and/or urinary diversion. With careful evaluation of bladder
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