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(PP)
BLADDER POLYPOSIS IN THE SETTING OF BLADDER EXSTROPHY-EPISPADIAS
COMPLEX (EEC)
Ali TOURCHI, Brian INOUYE, Heather DI CARLO, Ezekiel YOUNG and John GEARHART
James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins Universi, Baltimore, USA
PURPOSE
Bladder polyposis is common in the exstrophy-epispadias complex(EEC). Polyps usually lead to a delay in closure when
encountered at primary or secondary closure due to the altered quality of the bladder plate. The authors sought to
understand the outcomes of bladder closure, longitudinal bladder growth, continence rate, and factors that impact
continence outcomes in these patients.
MATERIAL AND METHODS
A prospectively kept database of 1212 patients with EEC was reviewed for bladder exstrophy (BE) and cloacal exstrophy
(CE) closed at the author’s institution with the diagnosis of bladder polyposis. Patients’ demographics, use of osteotomy,
other reconstructive operations, continence procedures, and ultimate urinary continence were recorded.
RESULTS
Thirty-three patients had primary polyps (Group 1) and 22 patients had secondary polyps(Group 2). The mean age at
closure of Group 1 and 2 were 6.06±8.07 months and 11.85±7.16 months, respectively. Polyp reoccurrence was
observed in just one patient. Primary polyp was significantly less frequent in females than males . Mean number of
polyps was significantly higher in male patients(p-value=0.008). Of these 55 patients with bladder polyposis, 50 had
more than 2 years of follow-up and were selected for further analysis. Forty-one percent of patients in Group 1 had
delayed closure due to polyposis. Of the patients who had undergone continence procedures, 66.7% of Group 1 and
69.2% of Group 2 were continent. On multivariate analysis, female gender was the only factor significantly associated
with continence . In Group 1, children who had delayed closure had similar bladder growth and capacity to those who
had neonatal closure.
CONCLUSIONS
This study suggested that primary polyps are more frequent in male patients and that continence after closure of a
polypoid bladder may be more successful in females. Importantly, delaying primary closure in the presence of polyps
does not influence the chances of successful bladder growth, capacity, or continence.