Complete primary repair of bladder exstrophy (CPRE): The long term outcome.
Hesham Arab, M.Sc.,MRCS, Helmy Omar, M.Sc., Ahmed Wadea, M.Sc., Ahmed AbdelHalim, M.Sc.,MRCS, Mohamed Soltan, M.B.B.Ch., Tamer Helmy, M.D, Mohamed Dawaba, M.D, Ashraf Tarek Hafez, M.D.
Urology and nephrology center,Mansoura University, Mansoura, Egypt.
The aim of the study is to demonstrate the long term anatomical and functional outcome of children with classic bladder exstrophy (CBE) who underwent CPRE.
Between November 1998 and October 2011, a total of 43 children with CBE underwent CPRE using Mitchell’s technique. The bladder and urethra were closed in continuity. Epispadias was repaired by total penile disassembly. Bilateral anterior iliac osteotomies were performed in all children. Ureteral stents and suprapubic tube were removed 10 and 14 days, respectively, after surgery. Follow up was done by renal bladder ultrasound (RBUS) every 3 months and Voiding cystourethrogram (VCUG) between 6 to 12 months post surgical intervention. Continence was defined as dryness more than 2 hours. RESULTS:
Mean+ SD follow up is 126 + 54.6 months. The repair resulted in hypospadias in 23/35 boys (65%), penoscrotal in 14, midpenile in 4 and distal penile in 4. Twelve (52%) were managed by duplay urethroplasty. Mustarde repair was done in 6 cases and Duckett’s repair in 5. Following catheter removal, 14/43 patients (32%) had suprapubic urine leakage that ceased spontaneously in 7 and required surgical intervention in the remaining patients. Early postoperative hydronephrosis (HN) was present in 10/43(23.3 %), low grade in 7 and high grade in 3.Last follow up RBUS showed resolution of HN in seven patients and persistence of low grade HN in 3. Eleven patients (25.6%) had febrile urinary tract infection that was treated conservatively. Early postoperative vesicoureteral reflux (VUR) was present in 33 children (76%), low grade in 27(81%). Last follow up VCUG revealed resolution in 16 cases (48%) and persistence of low grade VUR in 17(52%). Continence was achieved in 11 children (25.5%), 4 girls and 7 boys after CPRE only. Of the remaining 32 children, 4 children were continent after BNR only where their bladder capacity was adequate reaching more than 90 ml., while the other 28(65%) required augmentation ileocystoplasty (ACP) either alone in 11 (25%) or in combination with BNR in 17(39.5%).
CONCLUSIONS: CPRE as an approach for classic bladder exstrophy initially gained popularity. However, continence rate after CPRE only was achieved in one-fourth of the cases. Sixty five percent of the children needed augmentation ileocystoplasty with or without bladder neck reconstruction.
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