The Need for Augmentation after Bladder Exstrophy Closure

Purpose: Surgical procedures for continence in patients with exstrophy epispadias complex is challenging for the surgeon, patient, and family. Final outcome depends on the balance between the urine storage and the ability of complete bladder emptying with preservation of the upper urinary tract. The aim of this study was to assess the results of continence after Young-Dees-Leadbetter bladder neck reconstruction in patients with repaired bladder exstrophy and the need for augmentation based on pre-reconstruction bladder volume. Materials & Methods: Seventeen children with urinary incontinence secondary to bladder exstrophy wre treated in the Pediatric Surgery department (Ain Shams University Hospitals), during the period from June 2004 to June 2008,. Primary bladder closure was performed mainly in the neonatal period. All of them had their bladder capacity evaluated carefully under general anesthesia during the same session of bladder neck reconstruction, and augmentation cystoplasty was decided according to this assessment. Young-Dees-Leadbetter technique was used to reconstruct the bladder neck. Continence is assessed as good, acceptable, and poor according to the period of dry intervals and post voiding residual volume. Results: We have followed-up the 17 patients, 12 (70.5%) males and 5 (29.4%) females with their age ranging from 5 to 14 (mean 9) years, for a period ranging from 8 to 40 (mean 20.6) months. Patients were classified into 3 groups according to their pre-reconstruction bladder capacity (group A <= 50ml, group B >50ml but <100ml, and group C <= 100ml). There were four patients in group A, all of them underwent bladder augmentation in concomitant with bladder neck reconstruction. Two patients had good outcome. Five patients were in group B, two of them gained good outcome after subsequent bladder augmentation. Eight patients were in group C, reconstruction was done without augmentation to all of them. Four patients had good outcome. Conclusion: Urinary continence with preservation of the upper urinary tract is an achievable goal in patients with bladder exstrophy. Pre-reconstruction bladder capacity is important to achieve urinary continence. When bladder capacity is less than 100ml, bladder augmentation with clean intermittent catheterization (CIC) is the acceptable alternative.