Elsevier

Urology

Volume 57, Issue 4, April 2001, Pages 774-777
Urology

Pediatric urology
Determinants of continence in the bladder exstrophy population: predictors of success?

Presented at the American Academy of Pediatrics, Urology Section, Washington, D.C., October 1999.
https://doi.org/10.1016/S0090-4295(00)01102-XGet rights and content

Abstract

Objectives.

To delineate factors that may predict eventual urinary continence after bladder neck reconstruction (BNR) in the bladder exstrophy population.

Methods.

The records of 65 patients who underwent all phases of bladder exstrophy reconstruction at our institution between 1975 and 1997 with greater than 1-year follow-up were reviewed and data analyzed.

Results.

Fifty patients (77%) are continent day and night and voiding per urethra without need for augmentation or intermittent catheterization. Nine (14%) patients have social continence, dry for more than 3 hours during the day. Two patients required continent diversion for continence after failed BNR. Four patients are completely incontinent. The mean age of BNR was 4 years with a mean and median capacity of 93 and 85 cc (range 45 to 175). Analysis of bladder capacity measurements prior to BNR revealed that patients with a bladder capacity greater than 85 cc median capacity at the time of BNR had better outcomes. No correlation was found between the age of BNR and obtaining eventual continence. The mean time to daytime continence was 14 months (range 4 to 21) and the mean time to nighttime continence was 22 months (range 11 to 33).

Conclusions.

Determinants of continence in the bladder exstrophy population are multifactorial. In our experience, 77% of patients are completely dry, day and night, and 91% can achieve social continence, being dry for at least 3 hours. However, with careful evaluation of bladder capacity and bladder growth, urinary continence may be improved in this population with better patient selection.

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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