311 / 492
13:40 - 13:45
S26-2
(LO)
★
THE MEDIUM TERM CONTINENCE OUTCOMES OF THE KELLY PROCEDURE FOR
BLADDER EXSTROPHY REPAIR
Katerina PRODROMOU, Imran MUSHTAQ, Simon RAJENDRAN, Shabnam UNDRE, Naima SMEULDERS, Abraham
CHERIAN, Patrick DUFFY and Peter CUCKOW
Great Ormond street hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Spontaneous voiding continence is the functional goal in the management of bladder exstrophy. We present our medium
term results with the Kelly procedure, which incorporates a radical soft tissue dissection and reconstruction of the
bladder neck and penis.
MATERIAL AND METHODS
Medical notes of patients with classic bladder exstrophy who underwent a Kelly procedure at our institution between
2000 and 2014 were reviewed. Bladder exstrophy variants and those who had a primary closure elsewhere were
excluded. Continence was defined using a 4 level scoring-system and was assessed at 1, 3, 5 and 7-10 years post Kelly
procedure. Patients achieving levels 2/3(dry by day/dry day and night) were considered to have a good outcome.
Ultrasound imaging was used to monitor the upper renal tracts.
RESULTS
One hundred and ten consecutive patients(66-male, 44-female) were identified. All underwent the Kelly procedure,
regardless of bladder capacity. Mean follow-up was 4.74 years(range 0.3-13.6 years). Level 2/3 continence was
achieved in 64% of male and 79% of female patients at 5 years (60 patients in total) and 59% of male and 67% female
patients at 7-10 years(30 patients in total) post-Kelly. Statistical analysis showed significantly improved continence over
the first 5 years(Friedman test, p<0.005). Female patients had better continence levels at year 1 and comparable levels
with male patients after year 3(Mann-Whitney U-test, p=0.044(year 1), p=0.535(year 3), p=0.569(year 5)). Seven
patients required augmentation cystoplasty, one a mitrofanoff only and four are urethral clean intermittent
catheterization dependent.
CONCLUSIONS
The Kelly procedure can achieve high levels of spontaneous voiding continence in bladder exstrophy.