312 / 492
13:45 - 13:50
S26-3
(LO)
★
A CRITICAL APPRAISAL OF CONTINENCE IN BLADDER EXSTROPHY: LONG-
TERM OUTCOMES OF THE COMPLETE PRIMARY REPAIR
Jonathan ELLISON, Margarett SHNORHAVORIAN, Richard GRADY, Katie WILLIHNGANZ-LAWSON and Paul MERGUERIAN
Seattle Children's Hospital, Pediatric Urology, Seattle, USA
PURPOSE
Complete primary repair of bladder exstrophy (CPRE) is widely used for classic bladder exstrophy (CBE) closure. Studies
are limited given lack of long-term follow-up. We present our long-term experience with CPRE hypothesizing that, if
more stringent reporting criteria are employed, long-term continence rates following CPRE are lower than previously
reported
MATERIAL AND METHODS
We conducted a retrospective chart review on all patients with CBE undergoing initial CPRE at our institution from 1990
to present. We excluded patients with follow-up less than 7 years, age at last follow-up younger than 7, or incomplete
documentation. Continence was defined by volitional voiding at least every 3 hours and daytime dryness regardless of
nighttime continence status. Number of secondary continence procedures was assessed.
RESULTS
Of 60 patients with CBE followed at our institution, 25 met inclusion criteria with a median follow-up of 11.7 years
(range 7-20 years). Eight patients (32.0%) were continent, including 4 of 14 males (28.6%) and 4 of 11 females
(36.3%). Secondary continence procedures in continent and incontinent patients are shown in theTable. Six of 17
incontinent patients (35.3%) were on intermittent catheterization at last follow-up.
Continent
Incontinent
CPRE Alone
4
3
Bladder Neck Reconstruction (BNR)
1
2
Bladder Neck Injection (BNI)
1
6
BNR + BNI
2
6
CONCLUSIONS
Within the limitations of retrospective chart review, 16% of patients achieved continence by CPRE alone. Surgeries to
gain continence following CPRE are common. Strictly-defined long-term continence is achieved in one-third of patients.
Improved reporting strategies and assessments on patient impact are needed.