Continence and classic bladder exstrophy treated with staged repair

Purpose: Urinary continence rates after reconstruction of the urinary tract for classic bladder exstrophy are variable. We review our experience with procedures required to optimize continence. Materials and Methods: We retrospectively reviewed the charts of patients with classic bladder exstrophy undergoing staged reconstruction between 1976 and 2001. Continence was reviewed and associated with the procedures performed. Patients were considered continent if dry for greater than 3 hours with no stress incontinence and dry at night. Partial continence required dryness for 1 to 3 hours, minor stress incontinence and occasional nighttime leakage. Incontinent patients were dry for less than 1 hour, had significant stress incontinence or were wet at night. Patients were followed for a median of 12.5 years. Results: Continence was achieved in 43 of 48 patients (90%), partial continence in 4 (8%) and 1 (2%) remains incontinent. Continence occurred before bladder neck repair in 4 patients. Bladder neck repair alone (without augmentation) was performed in 38 patients at a median of 4.25 years, resulting in continence in 13 patients (34%). However, 6 of these 13 patients later required augmentation. Augmentation was performed in 33 patients, with 30 (91%) attaining continence after this procedure. Of those continent patients 10 void per urethra, and 8 void and use clean intermittent catheterization. Of the patients treated with bladder augmentation 93% required clean intermittent catheterization. Conclusions: Continence can be achieved in most patients with classic bladder exstrophy. However, augmentation was required in 30 of 43 patients (70%). Bladder neck reconstruction alone resulted in continence in only a third of the cases.