Outcomes in bladder exstrophy: 30 year's experience in a single-centre

Purpose The management of exstrophy-epispadias has changed markedly over the past thirty years, and long-term outcomes for different approaches of closure are not known. We have evaluated the outcomes and complications seen in all patients with exstrophy-epispadias complex managed at our institution over the past thirty years. Material and methods A retrospective notes review of all patients treated for exstrophy-epispadias complex was carried out. Basic patient demographics were recorded, as were details of all operations, complications, continence and renal function. Continence rates for patients with classic bladder exstrophy were calculated. Patients were divided into three groups on the basis of their date of birth (1975-1985, 1985-1995 and 1995-2005). Results A total of 62 patients with exstrophy-epispadias complex were treated at RCH from 1975-2005. The majority of these patients were treated from 1985-2005 (53), using the Kelly soft tissue mobilisation principle. The majority of patients had classic bladder exstrophy (42). Patients typically undergo a large number of operations in the management of classic bladder exstrophy and for complications of surgery. Complications remain commonplace, but a small number of patients had no complications. Most patients have normal renal function, but with attempts to achieve continence, more patients have some degree of renal impairment (25% of patients born 1995-2005). Continence without catheterisation is uncommon in patients with classic bladder exstrophy aged under 10 (25%), but continence improves dramatically in patients aged between 10 and 20 with 53% of patients in this age range being continent without catheterisation and a further 25% continent with catheterisation. Conclusions Bladder exstrophy remains a challenging condition to treat effectively. Complications are common, and continence is uncommon in the first decade of life. Secondary operations to improve bladder capacity and reconstruct the bladder neck have allowed the majority of patients to achieve continence in adolescence and early adult life.