SURGICAL MANAGEMENT OF BLADDER EXSTROPHY IN A COHORT OF PATIENTS
This retrospective study evaluated patients treated in the Pediatric Surgery Department of the Clinical Emergency Hospital for Children „Grigore Alexandrescu”, Bucharest, Romania, between 2006 and 2016. The inclusion criteria were the diagnosis of a classic form of bladder exstrophy. All the patients underwent primary bladder closure with or without bilateral anterior innominate and vertical iliac osteotomies. Regarding the pelvic osteotomies, we analyzed their use depending on the age the primary bladder closure was performed at. Complications after primary bladder closure, like dehiscence followed by bladder prolapse were also analyzed. Epispadias repair was performed in the male patients who underwent modern staged reconstruction of exstrophy (MSRE) and the bladder neck repair and other additional procedures were performed in order to achieve continence. The study included 35 patients from which 24 were male and 11 were female. All patients underwent primary bladder closure at a mean age of 2,62 months. Pelvic osteotomies were performed in 28,6% of the patients and one patient died after primary bladder closure. The major complication after primary bladder closure was wound dehiscence followed by bladder prolapse and occured in 22,85% of the patients. Epispadias repair was performed in 18 male patients who underwent MSRE. Mean age for epispadias repair was 1,21 years. Bladder neck repair was performed in 25 patients at a mean age of 5,13 years. Some of these patients needed additional interventions in order to achieve continence like bladder augmentation and urinary diversion. Continence was analyzed in 26 patients and the overall rate of continence was 84,64% (continent patients – 73,08%, partially continent – 11,54% and incontinent patients – 15,38%). The purpose of the treatment of bladder exstrophy is to achieve continence, a good esthetic result and to preserve renal function. One should use all the methods to achieve continence in patients, as bladder neck reconstruction alone is not enough sometimes.