Modern Management of the Failed Bladder Exstrophy Closure: A 50-yr Experience.
Classic bladder exstrophy
Continence
Failed closure
Osteotomy
Pediatric urology
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
15 03 2020
15 03 2020
Historique:
received:
22
06
2018
revised:
16
08
2018
accepted:
12
09
2018
pubmed:
8
10
2018
medline:
21
5
2021
entrez:
8
10
2018
Statut:
ppublish
Résumé
A failed closure of classic bladder exstrophy (CBE) has a negative long-term impact on the patient and the health care system. To investigate the outcomes of CBE patients with failed primary bladder closure. A database of 1317 exstrophy-epispadias complex patients was retrospectively reviewed for CBE patients with failed primary bladder closure from 1965 to 2017 with subsequent repeat closure. Repeat bladder exstrophy closure and subsequent continence procedure. Failed exstrophy closures are defined as occurrence of bladder prolapse, dehiscence, vesicocutaneous fistula, outlet obstruction, or combination of these factors. Successful repeat closures are defined as closures that require no further operative intervention as a consequence of these factors. Kaplan-Meier to determine time to successful repeat closure and receiver operator characteristic curve to determine the optimal time for secondary closure were determined. In total, 170 CBE patients had at least one repeat closure following a failed primary closure (115 male/55 female). With continued closure attempts, 166/170 (97.6%) patients were successfully closed. The median time to successful closure from birth was 12.9 mo (95% confidence interval: 11.7-15.7). Furthermore, 52/153 (34%) patients had more than one osteotomy. Of 215 total osteotomies, 50 (29.4%) were performed during the 170 failed primary closures, 128 (75.3%) during the 170second closures, and 27 (64.3%) during the 42 third closures. Of 96 patients with available continence data, 74 (77.1%) achieved urinary continence. A successful repeat closure is possible, especially when used in conjunction with a pelvic osteotomy. Continent urinary diversion yielded the highest continence rate in this cohort. We looked at outcomes of classic bladder exstrophy closure in a large population. Successful repeat closure is possible in the majority of cases when used with pelvic osteotomy. A majority of patients achieved urinary continence using a continent diversion.
Sections du résumé
BACKGROUND
A failed closure of classic bladder exstrophy (CBE) has a negative long-term impact on the patient and the health care system.
OBJECTIVE
To investigate the outcomes of CBE patients with failed primary bladder closure.
DESIGN, SETTING, AND PARTICIPANTS
A database of 1317 exstrophy-epispadias complex patients was retrospectively reviewed for CBE patients with failed primary bladder closure from 1965 to 2017 with subsequent repeat closure.
INTERVENTION
Repeat bladder exstrophy closure and subsequent continence procedure.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Failed exstrophy closures are defined as occurrence of bladder prolapse, dehiscence, vesicocutaneous fistula, outlet obstruction, or combination of these factors. Successful repeat closures are defined as closures that require no further operative intervention as a consequence of these factors. Kaplan-Meier to determine time to successful repeat closure and receiver operator characteristic curve to determine the optimal time for secondary closure were determined.
RESULTS AND LIMITATIONS
In total, 170 CBE patients had at least one repeat closure following a failed primary closure (115 male/55 female). With continued closure attempts, 166/170 (97.6%) patients were successfully closed. The median time to successful closure from birth was 12.9 mo (95% confidence interval: 11.7-15.7). Furthermore, 52/153 (34%) patients had more than one osteotomy. Of 215 total osteotomies, 50 (29.4%) were performed during the 170 failed primary closures, 128 (75.3%) during the 170second closures, and 27 (64.3%) during the 42 third closures. Of 96 patients with available continence data, 74 (77.1%) achieved urinary continence.
CONCLUSIONS
A successful repeat closure is possible, especially when used in conjunction with a pelvic osteotomy. Continent urinary diversion yielded the highest continence rate in this cohort.
PATIENT SUMMARY
We looked at outcomes of classic bladder exstrophy closure in a large population. Successful repeat closure is possible in the majority of cases when used with pelvic osteotomy. A majority of patients achieved urinary continence using a continent diversion.
Identifiants
pubmed: 30292419
pii: S2405-4569(18)30280-3
doi: 10.1016/j.euf.2018.09.008
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
383-389Informations de copyright
Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.