Exstrophy of the Bladder. I. Long-Term Results in a Series of 37 Cases Treated by Ureterosigmoidostomy

Abstract

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.

Ureterosigmoidostomy in Bladder Exstrophy

“…In our group of bladder exstrophy patients treated by ureterosigmoidostomy, the low incidence and type of perioperative problems and complications were compa rable to those of other studies using ureterointestinal anastomosis in the large bowel (colon conduit, ureterosig moidostomy) [10][11][12][13], whereas the poor experience of Lattimer et al [14] and Megaili and Lattimer [15] are difficult to explain.…”

“…In our single case of benign polypous tumor at the site of the ureterocolic anastomosis, 12 years of follow-up after tumor excision and ureter reimplantation did not reveal recurrence. The incidence of colon carcinoma after ureterosigmoidostomy is calculated as being 100-550 times higher than in the normal population without paying special attention to the operative technique with reflux prevention, geographic and racially correlated inci dence of colon carcinoma [11,51],…”

Long-Term Results of Surgical Treatment of Bladder Exstrophy

“…Recent long-term follow-up reviews (8-10, 13,14) fully support this point of view. Alterations of the mucosa occur in 100 % of the patients and according to Engel and Wilkinson (9), who have seen them in patients as soon as 5 days after birth, they exist already before birth.…”

“…As a result of all these complications anatomic bladder reconstruction has now been rejected by many of those who formerly supported the tech nique (8-10, 13), and who now turn to diversion ary techniques such as the ileal or colonic conduit (8), or the ureterosigmoidostomy (13,14). None theless, I believe that intestinoplastic techniques (5), 'before rendering a congenital into a iatrogenic malformation (urinary diversion) the child should be given an opportunity to become anatomically and socially normal', and this may be achieved by means of cystoplasty in a large number of cases.…”

Spontaneous Perforation of Augmented Bladder after Exstrophy Repair

“…Due to the poor long-term results concerning this technique [7][8][9][10], surgeons have reverted to primary exstrophy closure in the last 10 years [11,12], According to Gearhardt and Jeffs [ 13], it is sensible to perform aug mentation cystoplasty 2-3 years following exstrophy clo sure in case the bladder capacity failed to increase ade quately.…”