Abstract General Information

Title

BLADDER EXSTROPHY CONSORTIUM AFTER 8 YEARS: THE SHORT AND INTERMEDIATE TERM OUTCOMES

Introduction and objective

Bladder exstrophy (BE) is a complex surgical problem with no optimal repair. A multi-institutional BE consortium which utilized a standardized surgical technique for the complete primary repair of exstrophy (CPRE) was created in 2013. We hypothesized that this consortium would minimize short-term complications, optimize potential for volitional voiding with protection of the upper tracts and lower incidence of augmentation cystoplasty and/or bladder neck closure.

Method

Data from a prospective multi-institutional database were queried to identify children with classic BE who underwent primary CPRE from February 2013-February 2021. Short-term outcomes were considered <90 days, while intermediate-term outcomes were for a minimum 4 year follow-up.

Results

CPRE was performed in 92 patients over 8 years (30 girls, 62 boys), including 46 (17 girls, 29 boys) during the first 4 years. Median (IQR) age was 79 (50.3) days. Bilateral osteotomies were performed in 89 (97%). 16 (17%) underwent ureteral reimplantation and 13 (14%) underwent hernia repair concurrently. Short term complications occurred in 29 (31%): fistulae - 7 (bladder 1 (1%), urethra 6 (6%)), urethral stricture - 2 (2%), wound dehiscence without bladder involvement - 2 (2%), urinary retention (5 female, 1 male), and febrile UTI - 10 (11%). There were 14 subsequent surgeries within 90 days. Intermediate term outcomes were available for 40 of the 46 patients with 4-8 years of follow up. 33/40 had no evidence of hydronephrosis on ultrasound, and no patient had severe hydronephrosis. No patient underwent bladder neck closure or augmentation.

Conclusion

Short-term outcomes demonstrated no devastating complications, ie., penile injury or bladder dehiscence, however there were episodes of urinary retention, especially in girls. Intermediate-term data corroborate our approach of reserving BNC and AC for rare cases. Continence outcomes are on par with previous reports, with 40% of children with at least 4 years of follow-up having dry intervals of up to 1 hour. Since dryness seems to improve with increasing age, there may be further potential in improvements in voiding per urethra within our cohort