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

S26-12

(P)

SHORT-TERM OUTCOMES OF THE MULTI-INSTITUTIONAL BLADDER EXSTROPHY

CONSORTIUM: SUCCESSES AND COMPLICATIONS IN THE FIRST TWO YEARS OF

COLLABORATION

Joseph BORER

, Evalynn VASQUEZ

, Douglas CANNING

, John KRYGER

, Alexandra BELLOWS

, Dana WEISS

, Travis

GROTH

, Aseem SHUKLA

and Michael MITCHELL

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

PURPOSE

To increase experience and proficiency in the care of patients with bladder exstrophy (BE), the Multi-Institutional BE

Consortium (MIBEC) was formed. We report short-term outcomes and lessons learned from this unique model of

continuing surgical education.

MATERIAL AND METHODS

Three institutions alternately served as hosts with observation, commentary and critique by collaborating surgeons.

Employing the MIBEC method and protocol, we performed complete primary repair of BE (CPRE) with bilateral iliac

osteotomy at 1-3 months of age. Patients were prospectively followed for outcomes including complications.

RESULTS

From February 2013-February 2015, MIBEC surgeons performed CPRE in 28 consecutive patients (23 classic BE and 5

epispadias). Thirteen girls and 15 boys underwent CPRE at median age of 2.27 months. There were no dehiscences. 18

patients are without complications. One boy had a hypospadiac urethral meatus at CPRE completion. Hydronephrosis of

mild or moderate grade was present in 8 girls and 2 boys. One or more episode(s) of pyelonephritis occurred in 5 girls

and 1 boy. Two boys developed urethrocutaneous fistula, and 4 girls had varying degrees of urinary retention requiring

temporary clean intermittent catheterization (CIC). Complete retention developed in 2 of these 4 girls; 1 with a stenotic

bladder outlet will require diversion to vesicostomy, and 1 with meatal stenosis resulting in bladder rupture continues

CIC after repair.

CONCLUSIONS

Several girls had significant complications following CPRE. We noted a low complication rate in the boys, and are

encouraged by early signs of continence and spontaneous voiding in some boys and girls. Technical refinement of CPRE

is ongoing.