Primary Bladder Closure and Bladder Neck Reconstruction in Classical Bladder Exstrophy

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Abstract
The surgical results of 28 consecutive initial bladder closures and 25 consecutive initial bladder neck reconstructions performed for classical bladder exstrophy at the hospital between 1975-1982 are presented. Partial bladder prolapse occurred in 2 cases and complete wound dehiscence never occurred following the initital primary bladder closure. Urinary continence following bladder neck reconstruction was assessed from parental interviews. An excellent surgical result was defined either as achievement of a daytime dry interval for > 3 h, or < 1 incontinent episode per day. According to these parameters, an excellent surgical result was achieved in 86 and 80% of children, respectively. In 21 children evaluated with excretory urograms 1/2-6 yr after bladder neck reconstruction 10% of the renal units showed significant hydronephrosis and deterioration of function. The 2 patients who had upper tract deterioration were not followed postoperatively at this institution and the diagnosis of bladder outlet obstruction was delayed when excretory urograms were not obtained during the first postoperative year.