Detrusor Wraparound for Bladder Neck Reconstruction in Cohort of Children With Bladder Exstrophy

• Published in: Urology (Ridgewood, N.J.) Vol. 78; no. 4; pp. 881 - 885
• Main Author: Hafez, Ashraf T
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2011; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Bladder Exstrophy - surgery; Child; Cohort Studies; Endoscopy - methods; Female; Follow-Up Studies; Humans; Male; Malformations of the urinary system; Medical sciences; Nephrology. Urinary tract diseases; Reconstructive Surgical Procedures - methods; Retrospective Studies; Risk; Urinary Bladder - surgery; Urinary Incontinence; Urinary system involvement in other diseases. Miscellaneous; Urinary Tract - surgery; Urinary tract. Prostate gland; Urologic Surgical Procedures - methods; Urology; Human; Nephrology; Urinary system disease; Vesical exstrophy; Urinary tract disease; Congenital disease; Urology; Plasty; Treatment; Malformation; Surgery; Cohort study; Detrusor muscle; Bladder disease; Bladder neck; Child
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2011.04.060

Objective To evaluate the outcome of the detrusor wraparound bladder neck technique of bladder neck reconstruction in 28 children with bladder exstrophy. Methods The records of all patients with bladder exstrophy who underwent detrusor wraparound bladder neck were reviewed. A total of 28 consecutive patients were identified and included 21 boys and 7 girls, with a mean age at surgery of 8.3 years. All patients had undergone previous exstrophy closure (17 staged and 11 complete). Of the 28 patients, 8 (29%) had undergone previous endoscopic injection of a bulking agent at the bladder neck. At surgery, 13 patients (46%) required concomitant ileocystoplasty and a continent outlet. Continence was defined as complete dryness with no urine leakage either through the urethra or the continent outlet. Results The mean follow-up duration was 31 months (range 13-48). All augmented patients were continent using clean intermittent catheterization through the outlet. Complete dryness was achieved in 20 (71%) of 28 patients. However, the continence rate was only 47% in the nonaugmented group compared with 100% in the augmented group. Six of the incontinent children underwent bladder neck injection using a bulking agent but dryness was achieved in only 1 (17%). Conclusion The detrusor wraparound bladder neck technique is a viable option for bladder neck reconstruction for incontinent children after exstrophy closure. However, bladder augmentation and continent outlet construction are the pillars of optimal success. Injection of bulking agent at the bladder neck for failure has had poor success.