No AccessJournal of UrologyPediatric Urology1 Feb 1999URETHRAL OBSTRUCTION AFTER PRIMARY EXSTROPHY CLOSURE: WHAT IS THE FATE OF THE GENITOURINARY TRACT? LINDA A. BAKER, ROBERT D. JEFFS, and JOHN P. GEARHART LINDA A. BAKERLINDA A. BAKER More articles by this author , ROBERT D. JEFFSROBERT D. JEFFS More articles by this author , and JOHN P. GEARHARTJOHN P. GEARHART More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)61983-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the impact of posterior urethral obstruction after primary bladder exstrophy closure. Materials and Methods: A review of the records of patients with classic bladder exstrophy at our institution identified 29 boys and 12 girls with a mean age of 11.75 years who had had posterior urethral outlet obstruction after closure was done in the neonatal period. Results: Of these 41 patients 75% underwent closure elsewhere. At closure osteotomies were done in 13 patients and 23 were younger than 72 hours. Paraextrophy skin flaps were used at primary closure in 27 cases (66%). Obstruction presented as recurrent urinary tract infection, upper tract deterioration with or without renal failure, bladder stones, difficult catheterization, urethral stitch erosion, a full bladder on ultrasound, a prolonged dry interval, urinary retention, inability to catheterize, bladder rupture, rectal prolapse and epididymitis or prostatitis. Usually the initial obstructive episode developed within 60 days of closure and it was recurrent. Therapy included suprapubic catheter placement, vesicostomy, ureterostomy, nephrostomy and multiple urethral manipulations, such as dilation with or without steroid injection, internal urethrotomy, urethral stitch removal, clean intermittent catheterization or open urethroplasty. All 6 patients who underwent long-term diversion via vesicostomy, ureterostomy or a conduit for greater than 6 months required permanent bowel segments for reconstruction, while in 5 of the 6 who underwent short-term diversion via nephrostomy or suprapubic tube placement for less than 6 months reconstruction was bowel-free. Of the 36 children in whom functional reconstruction was performed 9 are undergoing staged reconstruction, reconstruction failed in 14, 4 are socially dry and 9 are continent. Conclusions: Posterior urethral obstruction after exstrophy closure markedly decreases the success of staged bladder reconstruction, presents a significant risk to the upper urinary tract and should be detected early. References 1 : The outcome of patients with classic bladder exstrophy in adult life. J. Urol.1996; 155: 1251. Link, Google Scholar 2 : Bladder exstrophy: a twenty-one year experience with functional reconstruction in 87 consecutive patients followed from birth. J. 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Link, Google Scholar From the Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byPurves J and Gearhart J (2008) Paraexstrophy Skin Flaps for the Primary Closure of Exstrophy in Boys: Outmoded or Updated?Journal of Urology, VOL. 180, NO. 4S, (1675-1679), Online publication date: 1-Oct-2008.YERKES E, ADAMS M, RINK R, POPE J and BROCK J (2018) HOW WELL DO PATIENTS WITH EXSTROPHY ACTUALLY VOID?Journal of Urology, VOL. 164, NO. 3 Part 2, (1044-1047), Online publication date: 1-Sep-2000. Volume 161Issue 2February 1999Page: 618-621 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information LINDA A. BAKER More articles by this author ROBERT D. JEFFS More articles by this author JOHN P. GEARHART More articles by this author Expand All Advertisement PDF downloadLoading ...
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