The modern staged repair of bladder exstrophy in the female: A contemporary series

Purpose The purpose of this study is to evaluate long-term outcomes in a select group of female patients who underwent the modern staged repair of exstrophy (MSRE). Material and methods Forty-one female patients were extracted from an institutionally approved exstrophy database. All had undergone primary closure by a single surgeon between 1988-2005 and all had a minimum of 5 years of follow-up. Primary closure occurred at a mean age of two months (range 4 hrs-3 months). Twelve underwent osteotomy at the time of primary closure. Mean age at bladder neck repair (BNR) was 4.2 years (range 39-65 months) when mean bladder capacity was 109 cc (range 80-179 cc). Results Thirty patients (74%) are continent day and night and voiding per urethra without augmentation or intermittent catheterization. Social continence, defined as dry for more than three hours during the day but damp at night, was found in a further 4 cases (10%). Seven patients are completely incontinent. The mean time to daytime continence was 12 months (range 4-16) and the mean time to night-time continence was 19 months (range 10-28). Patients with a mean capacity greater than 100 cc's had better outcomes. Six of the 30 patients achieved dryness after initial bladder closure only, and all 6 had osteotomy at the time of initial closure. Conclusions Female patients with a good bladder template who develop adequate capacity after a successful primary closure can achieve acceptable continence without bladder augmentation and intermittent catheterisation. A select group will develop continence with closure alone without the need for BNR.