Bilateral ureteral reimplantation at complete primary repair of exstrophy: Post-operative outcomes

Jarosz, Susan L.; Weaver, John; Weiß, Dana; Borer, Joseph G.; Kryger, John V.; Canning, Douglas A.; Groth, Travis W.; Lee, Ted; Shukla, Aseem R.; Mitchell, Michael E.; Röth, Elizabeth

doi:10.1016/j.jpurol.2021.10.012

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…During the collaboration, there have been differences in ancillary surgeries at the time of closure depending on patient characteristics and surgeon preference (such as ureteral reimplantation 19 and hernia repairs 20 ), as well as leaving the urethra at the glans or disconnecting it to create a hypospadias in order to gain more corporal length. However, the basic principle of the CPRE was followed for all closures.…”

Section: Discussionmentioning

confidence: 99%

Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes

Weiss,

Groth,

Abdulfattah

et al. 2024

Journal of Urology

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Purpose: Bladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes. Materials and Methods: A single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded. Results: CPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant's traction, and 2 in external fixation with Buck's traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days.

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Section: Discussionmentioning

confidence: 99%

Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes

Weiss,

Groth,

Abdulfattah

et al. 2024

Journal of Urology

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Exstrophy-Epispadias Complex

Lee

Borer

2023

Urologic Clinics of North America

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Current management of classic bladder exstrophy in the modern era

et al. 2023

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Background Classic bladder exstrophy is a complex, multi-system congenital malformation affecting formation of the genitourinary system, pelvis, and abdominal wall. Main body Historically children with this abnormality were consigned to poor outcomes and quality of life. Modern advancements in the diagnosis and management of this disorder have resulted in low mortality rates and shifted clinical focus toward optimizing quality of life. Conclusion Modern techniques in addition to recent discoveries in the diagnosis and delayed management of this disorder have enabled high rates of urinary continence, genital cosmesis, and an improved quality of life. This is an updated overview of the pathology, diagnosis, and management of this rare disorder.

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Bilateral ureteral reimplantation at complete primary repair of exstrophy: Post-operative outcomes

Cited by 4 publications

References 23 publications

Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes

Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes

Exstrophy-Epispadias Complex

Current management of classic bladder exstrophy in the modern era

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