Long Term Follow Up of Complete Bladder Exstrophy Repair. A Case Report

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ABSTRACT

OBJECTIVE: Bladder exstrophy is a congenital anomaly which is not always successfully managed by surgery. Major goals of surgical intervention in such cases are preservation of normal renal function, development of adequate bladder function and urinary continence and avoidance of future urinary tract infections. We present 5-year data on a patient who underwent complete repair of the bladder exstrophy. CASE REPORT: We describe a full term female infant who presented at birth with complete bladder exstrophy. Complete repair of the condition was performed 3 days after birth (Ransley technique). During hospitalization the patient had a positive urinary culture with Candida lusitaniae, enterococcus and septicemia with Klebsiella pneumoniae ESBL. The patient had no complications until the age of 20 months when she developed an episode of pyelonephritis and five further episodes of cystitis with E. coli. Radiographic testing showed small bladder capacity (23 ml at the age of 3 years), bilateral vesicoureteral reflux, a long stenotic urethra and no loss of renal function. Because of the recurrent urinary tract infections, dilatations of the stenotic urethra (Scheldinger technique) were successfully performed at the age of 3. Twenty-two months later the child had negative urinary cultures, a normal renal function and had also gained partial control of the bladder sphincters. CONCLUSIONS: Surgical repair of bladder exstrophy remains a challenging surgery for the pediatric urologist. Following surgical correction both early and long-term post-operative complications may be present. Longitudinal follow up is required by an experienced team of health care professionals

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  • 1. Epidemiology of bladder exstrophy and epispadias: a communication from the International Clearinghouse for Birth Defects Monitoring Systems. Teratology 1987;36:221.

  • 2. Shapiro E Lepor H Jeffs RD. The inheritance of the exstrophy-epispadias complex. J Urol 1984;132:308.

  • 3. Nelson CP Dunn RL Wei JT. Contemporary epidemiology of bladder exstrophy in the United States. J Urol 2005;173:1728.

  • 4. Mitchell M Grady R. Bladder and cloacal exstrophy. In: Holcomb GW III Murphy JP editors. Ashcraft’s Pediatric Surgery 5th ed. Philadelphia: W.B. Saunders; 2010:755-74.

  • 5. Gearhart JP Ben-Claim J Jeffs RD Sanders RC. Criteria for the prenatal diagnosis of classic bladder exstrophy. Obstet Gynecol 1995;85:961.

  • 6. Hamada H Shiina H et al. New ultrasonographic criteria for the prenatal diagnosis of cloacal exstrophy. J Urol 1999;162(6):2123-4.

  • 7. Halachmi S Farhat W Konen O et al. Pelvic fl oor magnetic resonance imaging after neonatal single stage reconstruction in male patients with bladder exstrophy. J Urol 2003;170:1505.

  • 8. Purves JT Baird AD Gearhart JP. The modern staged repair of bladder exstrophy in the female: A contemporary series. J Pediatr Urol 2008;4(2):150-3.

  • 9. Mitchell ME. Bladder exstrophy repair: Complete primary repair of exstrophy. Urology 2005;65(1):5-8.

  • 10. Joseph G. Surgical management and postoperative outcome of children with bladder exstrophy. Available at www.uptodate.com. Jan 2010.

  • 11. Gargollo PC Borer JG Diamond DA Hendren WH Rosoklija I Grant R et al. Prospective followup in patients after complete primary repair of bladder exstrophy. J Urol 2008;180(4 Suppl):1665-70.

  • 12. Borer J Gargollo PC Hendren WH Diamond DA et al. Early outcome following complete primary repair of bladder exstrophy in the newborn. J Urol 2005;174(4 Pt 2):1674-8.

  • 13. Shoukry AI Ziada AM Morsi HA Habib EI. Outcome of complete primary bladder exstrophy repair: Single-center experience. J Pediatr Urol 2009; 5(6): 496-9.

  • 14. Shnorhavorian M Grady RW Andersen A Joyner BD Mitchell ME. Long-term followup of complete primary repair of exstrophy: the Seattle experience. J Urol 2008;180(4 Suppl):1615-9.

  • 15. Gearhart J Baird A Nelson CP. Results of bladder neck reconstruction after newborn complete primary repair of exstrophy. J Urol 2007;178:1619.

  • 16. Schaeffer AJ Stec AA Purves JT Cervellione RM Nelson CP Gearhart JP. Complete primary repair of bladder exstrophy: a single institution referral experience. J Urol 2011;186(3):1041-7.

  • 17. Smeulders N Woodhouse CR. Neoplasia in adult exstrophy patients. BJU Int 2001;87:623.

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