Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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S25: VIDEO SESSION 1
Moderators: Kirstin Meldrum (USA), Margaret Baka-Ostrowska (Poland)
ESPU Meeting on Saturday 17, October 2015, 12:55 - 13:35
12:55 - 13:00
S25-1 (VP)
★ THE MULTI-INSTITUTIONAL BLADDER EXSTROPHY CONSORTIUM: TECHNICAL
STANDARDIZATION OF COMPLETE PRIMARY REPAIR OF EXSTROPHY IN THE BOY
Joseph G. BORER1, Evalynn VASQUEZ1, Douglas A. CANNING2, John V. KRYGER3, Dana WEISS2, Travis GROTH3, Aseem
SHUKLA2, Alexandra BELLOWS 1 and Michael E. MITCHELL3
1) Boston Children's Hospital, Urology, Boston, USA - 2) Children's Hospital of Philadelphia, Urology, Philadelphia, USA -
3) Children's Hospital of Wisconsin, Urology, Milwaukee, USA
INTRODUCTION
To increase experience and proficiency in the care of bladder exstrophy (BE), the Multi-Institutional BE Consortium
(MIBEC) was formed in February 2013. Our objective is to describe the technical standardization of complete primary
repair of BE (CPRE) in boys developed through this collaborative effort.
MATERIAL AND METHODS
Three institutions alternately served as hosts with observation, commentary, and critique by the collaborating surgeons
either present in person or via real-time video conferencing. Employing the MIBEC method and protocol, CPRE with
bilateral iliac osteotomy was performed at between 1-3 months of age. Patients were prospectively followed for
outcomes.
RESULTS
From February 2013-February 2015, MIBEC surgeons performed CPRE in 15 consecutive boys at median age of 2.9
months (0.4-28.8 months) for 13 boys with classic BE and 2 with penopubic epispadias. One boy had a midshaft
hypospadiac meatus at CPRE completion. There was no dehiscence. Mild hydronephrosis was present in 2 boys with
dilated distal ureters in 1, pyelonephritis occurred in 1 boy, and 2 boys developed urethrocutaneous fistula. Periods of
dryness with normal urinary stream have been observed in 5 boys. Techniques employed include initial ventral
dissection of urethra using bipolar electrocautery, a deliberate attempt to tailor the bladder neck with proximal urethral
lengthening, and interrupted suture technique for urethral and bladder closure.
CONCLUSIONS
CPRE technique in the boy was standardized through this MIBEC. We noted a low complication rate and are encouraged
by early signs of continence and spontaneous voiding in some. Technical refinement of CPRE and standardization of
postoperative care are ongoing.