Management of bladder exstrophy in adulthood: report of 5 cases

Abstract

Objective: To report our experience in the management of adult classic bladder exstrophy.

Patients and methods: During 1977-2006 we treated five adult males presenting with classic exstrophy-epispadias complex. Patient age at presentation ranged from 17 to 30 with a mean age of 23 years. Four patients had received no previous treatment and one underwent previous ureterosigmoidostomy. Work-up included evaluation of upper tract and bladder biopsy. Bladder patch condition was variable. Surgery involved bladder preservation in the three patients who underwent primary repair, including bladder closure, bladder neck reconstruction and epispadias repair; two of them also had augmentation ileocystoplasty. The remaining two patients underwent ureterosigmoidostomy, cystectomy and epispadias repair. Abdominal wall closure was by fasciocutaneous M-plasty. Osteotomy was not done in any case.

Results: In patients with bladder preservation, one patient was continent (>3 h) and voided normally whereas the other two showed day and night continence (2-3 h) with mild stress incontinence. Patients were satisfied with functional outcome. Ultrasound and intravenous pyelography showed preservation of upper tract. Follow-up period ranged from 1 to 8 years.

Conclusion: Patients with bladder exstrophy presenting in adulthood should not be denied the opportunity of primary reconstruction with bladder preservation in the absence of significant histological changes in the bladder mucosa.

Keywords: Bladder exstrophy; Ectopia vesica.