Bladder Reconstruction in Exstrophy

Abstract

During a 5 yr period, 35 patients with complete exstrophy of the bladder were treated. In 31 cases, reconstruction was attempted using a 3-step procedure. The bladder was closed with a posterior iliac osteotomy and in the male patient the penis was lenthened. An antireflux procedure and bladder neck reconstruction were done. The modification of the Young-Dees procedure was used, which allowed reconstruction of the vesicourethral angle and creation of an anterior muscular loop. The anterior epispadias was repaired. Of 16 patients who completed surgical treatment > 1 yr ago, 6 female and 5 male subjects are cured, i.e., continent with a normal excretory urogram and no reflux. One male patient is improving and 4 boys are failures. The operative technique, postoperative training and results and selection of patients for functional closure are discussed.