Back to 2014 Fall Congress Meeting Abstracts

BACKGROUND: Continent reconstruction of bladder exstrophy aims either to achieve controlled obstruction or a physiologically functioning bladder outlet, in one or several stages, with or without osteotomies. Continence follows the development of bladder capacity. We present the results of our approach: an early primary bladder closure without osteotomies, followed by radical soft tissue (Kelly) reconstruction in the second year of life.
METHODS: Since 1999, consecutive patients with classic bladder exstrophy have entered our surgical protocol. From the start, our unselected patients have been regularly assessed by our nurse specialists by non-invasive urodynamics and ultrasound. After Kelly operation, emerging continence has been categorised using a family friendly adaptation of ICCS definitions, shown in the table:

Continence Level	Clinical Correlation
I	Retaining urine with a ‘dry interval’; some control but still needing to wear protection
II	Sufficient dry intervals by day; in underwear and not needing protection; wet at night
III	Dry both by day and by night; no protection or accidents; like a “normal” child

RESULTS: Of 101 patients (70M, 31F); 93 have been followed for more than a year post Kelly, 53 > 5 years, 22 > 10 years. Kelly operations were all performed by the same surgeon. In some patients bladder closure and epispadias repairs were done before referral.

Male Results	1 year	3 years	5 years	10 years
Number	46	35	30	16
I	36	12	4	1
II	10	18	12	6
III	-	4	11	7
Augmentation	-	1	3	2

Female Results	1 year	3 years	5 years	10 years
Number	23	15	14	6
I	12	4	1	-
II	10	8	9	2
III	1	2	2	2
Augmentation	-	1	2	2

Secondary Cases (M+F)	1 year	3 years	5 years	10 years
Number	24	11	9	-
I	9	1	0	-
II	14	8	4	-
III	1	1	3	-
Augmentation	-	1	2	-

CONCLUSIONS: The Kelly operation has been successful in achieving continence, which evolves as the child grows and bladder capacity increases: At 10 years, 81% of males are dry by day, 44% by day and night and 13% have been augmented, whilst in females 67% are dry by day, 33% also at night and 33% have been augmented. Secondary cases followed to 5 years show 78% daytime continence, 33% also at night and 22% have been augmented. Videourodynamics has demonstrated good detrusor function during volitional voiding.