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Surgery Insight: advantages and pitfalls of surgical techniques for the correction of bladder exstrophy

Nature Clinical Practice Urology volume 3, pages 95–100 (2006)Cite this article

Abstract

Staged reconstruction repair of bladder exstrophy results in hydronephrosis or renal scarring in 15–25% of patients. A cosmetically acceptable and functional phallus can be achieved in 85% of patients, 20–30% of whom will require more than one operation for penile reconstruction. Episodes of penile glans loss or corporal loss are rarely reported with this technique. Widely disparate results relating to complete urinary continence and volitional voiding have been published, with urinary continence reported to occur in 7–85% of patients. The need for bladder augmentation to obtain urinary continence also varies, with reports that somewhere between 10% and 90% of patients require an augmentation procedure to gain urinary continence. Complete primary repair of bladder exstrophy using the penile disassembly technique results in hydronephrosis or renal scarring in 0–30% of patients, and hypospadias, as a consequence of this repair, will occur in 30–70% of patients. Loss of the glans and corpora appear more frequently with penile disassembly than in staged reconstruction of bladder exstrophy, however, the exact incidence of this complication is unknown. Reported complete urinary continence and volitional voiding rates are also varied following penile disassembly, ranging from 25–65%. A modified bladder-neck reconstruction to gain urinary continence is reportedly required in 15–90% of patients, with 5–10% requiring both bladder augmentation and bladder-neck reconstruction. Experience with complete primary repair of bladder exstrophy, using the penile disassembly approach, seems promising but is not a panacea. To outline the risks and benefits regarding the various surgical techniques for bladder exstrophy, we would recommend the establishment of a national registry for patients with this disorder.

Key Points

  • The aims of reconstructive surgery in patients with bladder exstrophy are to maintain kidney function, achieve urinary continence and to create or preserve functionally normal external genitalia

  • As repair of bladder exstrophy is conducted at a young age, complications associated with surgery might take many years to become evident

  • Although favorable results in terms of renal function and cosmetic appearance have been achieved with staged reconstruction, persistent urinary incontinence is a common complication, and as a result this procedure has become less popular

  • For complete primary repair to be most effective, it is best conducted as soon as possible following birth

  • Complete primary repair offers preservation of renal function and the promise of continence in many patients; however, hypospadias and ischemic changes to the penis can arise

  • Outcomes of both staged reconstruction and complete primary repair are variable, and a national database should be established in order to collect information on success rates and complications associated with repair of bladder exstrophy

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  1. Professor of Urology in the Department of Urology, Mayo Clinic, Rochester, MN, USA

    Douglas A Husmann

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  1. Douglas A Husmann
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Correspondence to Douglas A Husmann.

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Husmann, D. Surgery Insight: advantages and pitfalls of surgical techniques for the correction of bladder exstrophy. Nat Rev Urol 3, 95–100 (2006). https://doi.org/10.1038/ncpuro0407

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